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•NRLF 


Fagge 

w  W 


MEDICAL    *§CH©(DL 


Gift  of 
ALICE  F.   MAXWELL,   M.D, 


THE 

POCKET  ANATOMY 


SIXTH    EDITION,    REVISED    AND    EDITED 

BY 

C.  H.1FAGGE,  M.B.,  M.S.  LOND.,  F.R.C.S. 


THIRTIETH    THOUSAND 


N  E  W     YORK 

WILLIAM     WOOD     &     COMPANY 
MDCCCCVIII 


PREFACE 

IN  compiling  this  edition  I  have  borrowed  from  Quain's 
'Anatomy,'  Cunningham's  'Text-book  of  Anatomy,'  and 
Morris's  'Treatise  of  Anatomy.'  It  therefore  seems  that 
the  old  name  of  '  The  Pocket  Gray '  no  longer  accurately 
describes  this  little  volume,  so  on  the  advice  of  the  pub- 
lishers it  has  been  altered  to  that  of  '  The  Pocket  Anatomy.' 
The  whole  book  has  been  carefully  revised,  and  many 
descriptions  have  been  changed,  among  which  the  chief  is 
the  substitution  of  Jonnesco's  account  of  the  iliac  and  pelvic 
colon  and  rectum  for  that  of  the  sigmoid  and  rectum  of 
previous  editions. 


C.  H.  FAGGE. 


3,  DEVONSHIRE  PLACE, 
LONDON,  W. 


5954". 


THE   POCKET  ANATOMY 


THE  ARTICULATIONS. 

The  Classification  of  Joints. 

Synarthrosis  (Immovable  Joint). 
Varieties : — 

Sutura. 

Suit-varieties : — 
S.  Dentata. 
S.  Serrata. 
S.  Limbosa. 
S.  Squamosa. 
S.  Harmonia. 

Synchondrosis— may  become  a  Synostosis. 
Schindylesis. 
Gomphosis. 

Amphiarthrosis  (allowing  slight  movement). 
Varieties : — 

Symphysis. 
Syndesmosis. 

Diarthrosis  (Movable  Joint). 
Varieties  :— 

Arthrodia,  or  Gliding  Joint. 

Enarthrosis,  or  Ball-and-Socket  Joint. 

Ginglymus,  or  Hinge  Joint. 

Condyloid. 

Reciprocal  Reception,  or  Saddle  Joint. 

Trochoid,  or  Pivot  Joint. 

ARTICULATIONS  OF  THE  TRUNK. 

I. — ARTICULATIONS    OF   THE    VERTEBRAL   COLUMN. 

(A )  Joints  between  the  bodies  which  are  amphiarthroses. 
(J3)    Joints   between   the   neural    arches   by   means   of  the 


2  THE  POCKET  ANATOMY 

articular  processes  which  are  diarthroses  of  the  arthrodial 
variety. 

(A)  The  Ligaments  of  the  Bodies. 

The  anterior  common  ligament :  a  broad  band  of  fibres, 
extending  along  front  of  bodies  of  vertebras,  from  axis  to 
sacrum.  It  consists  of  two  sets  of  fibres,  superficial  and  deep ; 
the  former  extending  between  the  bodies  of  two  or  more 
vertebras,  the  latter  only  between  adjacent  vertebras.  The 
fibres  are  attached  principally  to  the  intervertebral  sub- 
stances. 

The  posterior  common  ligament  is  within  the  spinal  canal, 
and  extends  along  back  of  bodies  of  the  vertebras  from  axis  to 
sacrum,  being  broad  opposite  the  intervertebral  discs,  and 
narrow  opposite  the  bodies,  except  in  the  neck,  where  it  is  as 
wide  as  the  bodies.  It  is  attached  to  the  discs  and  contiguous 
parts  of  the  bodies  of  the  vertebrae. 

The  intervertebral  substances,  found  between  the  vertebrae 
from  axis  to  sacrum.  The  circumference  of  each  consists  of 
layers  of  oblique  parallel  fibres  of  white  fibrous  tissue,  en- 
closing a  central  part  of  pulpy  elastic  material.  They  are 
thickest  in  the  lumbar  region,  and  they  give  the  peculiar 
curves  to  the  column  by  their  differences  in  thickness. 

(B)  The  Ligaments  of  the  Lamina. 

The  ligamenta  subflava  connect  the  laminae  of  the  vertebrae 
from  the  axis  to  the  sacrum.  Each  ligament  is  attached  to 
the  anterior  inferior  edge  of  the  lamina  above,  and  to  thf 
posterior  superior  edge  of  the  lamina  below. 

The  Ligaments  of  the  Articular  Processes. 

Capsular  ligaments  surround  the  articular  processes,  those 
in  the  cervical  region  being  the  loosest.  Each  is  lined  by  a 
synovial  membrane. 

The  Ligaments  of  the  Spinous  Processes. 

The  interspinous  ligaments  extend  in  all  regions  of  the 
vertebral  column  between  the  spinous  processes  of  the  ver- 
tebras, running  from  root  to  apex. 

The  supraspinous  ligament:  a  fibrous  cord,  joining  the 
tips  of  the  vertebrae,  and  extending  from  the  seventh  cervical 
to  the  first  sacral. 

The  ligamentum  nuchse  continues  the  supraspinous  liga- 
ment upwards.  It  consists  of  a  superficial  layer,  extending 
from  the  spine  of  the  seventh  cervical  to  the  external  occipital 
protuberance,  and  a  deep  layer  attached  to  the  spines  of  the 
cervical  vertebrae  and  the  occipital  crest. 

The  Ligaments  of  the  Transverse  Processes. 

Intertransverse  ligaments  extend  between  the  transverse 


A  RTIC  ULA  TIONS  3 

processes,  often  absent  in  the  cervical,  thin  in  the  lumbar, 
but  round  and  well  marked  in  the  dorsal  region. 

II.— ARTICULATION    OF   ATLAS   WITH   AXIS. 

The  atlo-axoid  articulation  consists  of  four  joints — (a)  a 
pivot  joint  consisting  of  two  parts,  (i.)  between  odontoid  pro- 
cess and  anterior  arch  of  atlas,  and  (ii.)  between  odontoid 
process  and  transverse  ligament ;  (b)  two  arthrodial,  between 
the  articular  processes. 

The  anterior  atlo-axoid  ligament  consists  of  a  superficial 
and  a  deep  part.  The  superficial  part  continues  the  anterior 
common  ligament.  It  is  attached  above  to  the  anterior 
tubercle  of  the  atlas  ;  and  below  to  the  body  of  the  axis  and 
base  of  the  odontoid  process.  The  deep  part  is  broad,  and 
reaches  from  the  lower  border  of  the  anterior  arch  of  atlas  to 
the  base  of  odontoid  process  and  body  of  axis. 

The  posterior  atlo-axoid  ligament :  a  thin  layer,  connected 
above  to  the  lower  border  of  the  posterior  arch  of  atlas,  and 
below  to  the  upper  edge  of  laminas  of  axis,  pierced  by  the 
second  cervical  nerve. 

The  transverse  ligament  keeps  the  odontoid  process  in  its 
place  ;  it  is  attached  on  each  side  to  a  tubercle  on  the  inner 
surface  of  the  superior  auricular  process  of  the  atlas.  A  thin 
bundle  of  fibres  passes  upwards  from  the  middle  of  the  pos- 
terior surface  to  the  basilar  process,  and  a  like  process  down- 
wards to  the  body  of  the  axis.  These  two  processes,  together 
with  the  transverse  ligament,  form  the  cruciform  ligament. 

Capsular  ligaments  as  in  ordinary  vertebrae,  but  supple- 
mented at  the  posterior  and  inner  part  by  an  accessory  liga- 
ment passing  downwards  and  inwards  to  the  base  of  the 
odontoid  process  (accessory  atlo-axoid  ligaments'). 

Synovial  membranes  :  besides  those  of  capsular  ligaments, 
two  ;  one  in  front  and  one  behind  the  odontoid  process,  the 
latter  often  communicating  laterally  with  one  of  the  occipito- 
atloid  joints. 


HI. — ARTICULATION   OF   ATLAS   WITH    OCCIPITAL   BONE. 

The  anterior  occipito-atloid  ligament  consists  of  a  super- 
ficial and  a  deep  part.  The  superficial,  rounded,  pa'sses  from 
the  basilar  process  of  the  occiput  to  the  anterior  tubercle  of 
the  atlas.  The  deep  part  is  broad,  and  attached  above  to  the 
anterioredge  of  the  foramen  magnum,  and  below  to  the  upper 
margin  of  anterior  arch  of  atlas. 

X — 2 


4  THE  POCKET  ANATOMY 

The  posterior  occipito-atloid  ligament,  thin  and  mem- 
branous, is  attached  above  to  posterior  margin  of  foramen 
magnum  ;  below,  to  upper  border  of  posterior  arch  of  atlas. 
(Perforated  on  each  side  by  vertebral  artery  and  subocdpital  or  first 
cervical  nerve. ) 

The  lateral  occipito-atloid  ligaments  :  one  on  each  side ; 
attached  above  to  the  jugular  process  of  occiput,  and  below 
to  the  base  of  atlantal  transverse  process. 

Capsular  ligaments  as  in  ordinary  vertebrae. 

IV. — LIGAMENTS   BETWEEN   THE   AXIS   AND   OCCIPITAL   BONE. 

The  occipito-axoid  ligament  (apparatus  ligamentosus  colli) :  a 
continuation  of  the  posterior  common  ligament,  connected 
above  with  basilar  groove  of  occiput,  and  below  to  posterior 
surface  of  the  body  of  axis. 

The  odontoid  or  check  ligaments  consist  of  two  cords 
passing  from  the  sides  of  the  apex  of  the  odontoid  process  to 
the  rough  surface  on  the  inner  side  of  each  condyle  of  the 
occipital  bone.  In  the  interval  between  the  two  the  ligamen- 
tum  suspensorium  dentis  passes  from  the  apex  of  the  odontoid 
process  to  the  anterior  margin  of  the  foramen  magnum. 

V.  — TEMPORO-M AXILLARY  ARTICULATION. 

The  condyle  of  the  lower  jaw  articulates  with  the  anterior 
part  of  the  glenoid  fossa,  and  with  the  eminentia  articularis 
of  the  temporal  bone,  the  joint  being  divided  into  an  upper 
and  a  lower  synovial  cavity  by  an  interarticular  fibro-cartilage. 

The  external  lateral  ligament,  attached  above  to  tubercle 
and  lower  border  of  zygoma ;  below,  to  outer  surface  and 
posterior  edge  of  neck  of  lower  jaw. 

The  internal  lateral  ligament  is  attached  above  to  the 
spinous  process  of  the  sphenoid,  and  below  to  the  inner 
margin  or  lingula  of  the  dental  foramen  of  lower  jaw. 

The  capsular  ligament :  thin  and  loose,  attached  above  to  the 
edge  of  anterior  half  of  glenoid  cavity  and  articular  eminence ; 
below,  it  surrounds  neck  of  the  condyle. 

The  interarticular  fibro-cartilage  has  an  oval  shape ;  the 
upper  surface  is  concavo-convex  from  before  backwards,  and 
slightly  convex  transversely ;  the  lower  surface  is  concave ; 
the  edge4  is  attached  to  the  capsule,  and  part  of  the  external 
pterygoid  muscle  is  inserted  into  its  anterior  margin. 

Synovial  membranes,  two  in  number,  one  above  and  one 
below  the  fibro-cartilage ;  the  upper  being  the  larger. 

The  stylo-maxillary  ligament:   a  band  of  fibrous  tissue 


ARTICULATIONS  5 

extending  from  the  styloid  process  to  angle  and  posterior 
border  of  ramus  of  the  jaw,  which  is  derived  from  the  deep 
cervical  fascia  (p.  26). 

(Stylo -hyoid  ligament:  a  fibrous  cord  extending  from  the 
styloid  process  to  small  cornu  of  hyoid  bone). 

VI. — ARTICULATION    OF    THE    RIBS   WITH    THE   VERTEBRA. 

(a)  Articulations  between  the  Heads  of  the  Ribs  and  the  Bodies 
of  the  Vertebra. 

Arthrodial  joints  held  together  by  the  following  ligaments : — 

The  anterior  costo-vertebral  or  stellate  ligament  is  com- 
posed of  three  fasciculi,  which  radiate  from  the  anterior  surface 
of  the  head  of  the  rib.  The  superior  fasciculus  passes  to  the 
body  of  the  vertebra  above  ;  the  inferior  fasciculus  to  the  body 
of  the  vertebra  below  ;  the  middle  fasciculus  to  the  interverte- 
bral  substance. 

A  capsular  ligament  surrounds  articulation  between  the 
head  of  the  rib  and  the  articular  surface  formed  by  two 
vertebrae. 

The  interarticular  ligament  divides  the  joint  into  two  parts, 
each  of  which  has  a  separate  synovial  membrane.  It  passes 
between  ridge  on  head  of  rib  and  intervertebral  substance. 
(Absent  in  the  ist,  loth,  nth,  and  iath  ribs.) 

(b)  Articulations  of  the  Necks  and  Tubercles  of  the  Ribs  with 
the  Transverse  Processes  of  the  Vertebra. 

Arthrodial  joints  held  together  by  the  following  ligaments: 

The  anterior  or  superior  costo-transverse  ligament  passes 
from  the  upper  border  of  neck  of  rib,  to  lower  border  of 
transverse  process  above.  (Absent  in  ist  rib.) 

The  middle  costo-transverse  or  interosseous  ligament :  a 
short  thick  band  passing  from  the  anterior  surface  of  the 
transverse  process  to  the  posterior  surface  of  neck  of  corre- 
sponding rib.  (Rudimentary  in  nth  and  iath  ribs.) 

The  posterior  costo-transverse  ligament  passes  from  apex 
of  transverse  process  to  rough  non-articular  part  of  tubercle 
of  rib.  (Absent  in  nth  and  i2th  ribs.) 

The  capsular  ligament  surrounds  articular  surfaces,  en- 
closing a  small  synovial  membrane.  (This  articulation  is 
absent  in  the  nth  and  i2th  ribs.) 

VII. — ARTICULATION  OF  THE  UPPER  SEVEN  COSTAL  CARTILAGES 
WITH  THE  STERNUM. 

The  anterior  chondro-sternal  ligament :  a  broad  thin  band, 
radiating  from  extremity  of  the  rib  cartilage  to  the  sternum. 


6  THE  POCKET  ANATOMY 

The  superior  fasciculi  pass  obliquely  upwards,  the  inferior 
downwards,  and  the  middle  horizontally. 

The  posterior  chondro-sternal  ligament  is  an  indistinct 
band  of  fibres  radiating  from  the  posterior  surface  of  the 
inner  end  of  the  costal  cartilage  to  the  back  of  the  sternum. 

The  capsular  ligament  surrounds  the  joint,  and  encloses  a 
synovial  membrane  (In  the  ist  there  is  no  synovial  mem- 
brane ;  in  the  2nd  and  3rd  there  are  2,  the  joint  being  divided 
by  an  interarticular  ligament  passing  between  end  of  the 
costal  cartilage  and  cartilage  between  adjacent  pieces  of  the 
sternum.  (The  4th,  5th,  6th,  and  yth  have  one  each.) 

VIII. — ARTICULATIONS   OF   THE   CARTILAGES  OF  THE  RIBS  WITH 
EACH    OTHER. 

The  cartilages  of  the  6th,  yth,  and  8th  ribs  articulate  with 
each  other  by  an  oval  shaped  facet,  each  having  a  capsule 
enclosing  a  synovial  membrane. 

IX.— ARTICULATIONS  OF  THE  RIBS  WITH  THEIR  CARTILAGES. 

The  costal  end  of  each  cartilage  fits  into  a  depression  in  the 
sternal  end  of  the  rib,  and  is  bound  down  by  periosteum. 

X.— ARTICULATIONS  OF  THE  STERNUM. 

The  ist  and  2nd  pieces  are  united  by  a  piece  of  cartilage, 
kept  together  by  the  following  two  ligaments  : — 

The  anterior  intersternal  ligament  consists  of  longitudinal 
fibres,  which  blend  with  the  costo-sternal  ligaments. 

The  posterior  intersternal  ligament:  similar  to  the  pre- 
ceding, placed  on  the  back  of  the  sternum. 

XI. —ARTICULATION    OF  THE   PELVIS  WITH  THE  SPINE. 

The  following  ligamentsconnect  the  5th  lumbar  vertebra  with 
the  sacrum,  and  are  similar  to  the  common  vertebral  ones  :— 

1.  The  continuations  of  the  anterior  and  posterior  common 
ligaments. 

2.  The  intervertebral  substance  between  the  last  lumbar 
vertebra  and  the  sacrum. 

3.  The  ligamenta  subflava  between  the  laminae  of  the  last 
lumbar  vertebra  and  the  margins  of  upper  opening  of  the 
sacral  canal. 

4.  Capsular  ligaments,  between  the  articular  processes. 

5.  Interspinous  and  supraspinous  ligaments. 

Besides  these,  there  are  the  following  special  ligaments : 
The  lumbo-sacral  or  sacro-vertebral  ligament:   attached 
above  to  the  front  of  tip  of  transverse  process  of  the  5th 


ARTICULATIONS  7 

lumbar  vertebra;  below,  to  the  outer  border  of  the  front  of 
the  lateral  mass  of  the  sacrum. 

The  ilio-lumbar  ligament  passes  from  the  tip  of  transverse 
process  of  5th  lumbar  vertebra,  to  the  crest  of  L.um  in  front 
of  sacro-iliac  articulation. 

XII. — ARTICULATIONS   OF   THE    PELVIS. 

(a)  Sacro-iliac  Joint. 

The  sacro-iliac  articulation  is  an  amphiarthrosis,  formed 
between  the  lateral  surfaces  of  the  sacrum  and  ilium.  The 
auricular  or  anterior  parts  of  the  articular  surfaces  are  covered 
with  cartilage,  and  connected  by  the  two  following  ligaments : — 

The  anterior  sacro-iliac  ligament :  small  bands  passing 
obliquely  from  sacrum  to  ilium  on  the  anterior  surface. 

The  posterior  sacro-iliac  ligament  consists  of  strong  inter- 
osseous  bands  passing  chiefly  downwards  and  inwards  from 
the  rough  part  of  the  ilium  behind  the  cartilage,  to  the 
posterior  part  of  the  sacrum.  There  are  two  superior,  passing 
from  the  ist  and  2nd  transverse  sacral  tubercles,  and  one 
sometimes  called  the  oblique  sacro-iliac  ligament,  which  reaches 
from  the  posterior  superior  iliac  spine  to  the  3rd  transverse 
sacral  tubercle. 

(b)  Ligaments  between  the  Sacrum  and  Ischium. 

The  great  (or  posterior]  sacro-sciatic  ligament,  attached  by 
its  base  to  the  posterior  inferior  iliac  spine,  to  the  4th  and  5th 
transverse  sacral  tubercles,  and  to  the  lower  part  of  the  edge 
of  the  sacrum  and  coccyx  ;  passes  downwards,  outwards,  and 
forwards,  to  be  attached  to  the  inner  edge  of  the  ischial 
tuberosity  and  to  the  inner  margin  of  the  ramus,  forming  the 
falciform  ligament. 

The  small  (or  anterior]  sacrp-sciatic  ligament,  attached  by 
its  apex  to  the  spine  of  the  ischium,  and  by  its  base  to  the 
lateral  margin  of  the  coccyx  and  sacrum. 

Foramina. — Between  the  great  sacro-sciatic  ligament  and 
the  innominate  bone  is  a  space  divided  into  two  by  the  small 
sacro-sciatic  ligament ;  the  part  above  this  ligament  being  the 
great  sacro-sciatic  foramen,  and  the  part  between  the  two  liga- 
ments the  small  sacro-sciatic  foramen.  The  large  foramen 
transmits  pyriformis,  together  with  superior  gluteal,  sciatic 
and  internal  pudic  vessels,  the  superior  gluteal,  great  and 
small  sciatic,  pudic  and  inferior  gluteal  nerves,  and  nerves  to 
the  obturator  internus,  quadratus,  and  gemelli.  The  small 
foramen  transmits  the  obturator  internus,  whilst  its  nerve, 
together  with  the  internal  pudic  vessels  and  pudic  nerve,  re- 
enters  the  pelvis  by  it. 


8  THE  POCKET  ANATOMY 

(c)  Articulation  of  the  Sacrum  and  Coccyx. 
Araphiarthrodial  joint. 

The  anterior  sacro-coccygeal  ligament,  very  indistinct, 
passes  from  anterior  surface  of  sacrum  to  that  of  the  coccyx. 

The  posterior  sacro-coccygeal  ligament  passes  from  the 
margin  of  the  lower  orifice  of  the  sacral  canal  to  the  posterior 
surface  of  the  coccyx. 

Interarticular  ligaments  between  the  cornua.  Lateral 
ligaments,  passing  from  the  lower  lateral  angle  of  sacrum  to 
transverse  process  of  ist  piece  of  coccyx. 

A  fibro-cartilage  is  placed  between  the  sacrum  and  the 
coccyx. 

(d)  Symphysis  Pubis. 

Amphiarthrodial  joint  bound  together  by  the  following 
ligaments : — 

The  anterior  pubic  ligament  consists  of  several  layers  of 
fibres  crossing  the  symphysis  horizontally  in  front. 

The  posterior  pubic  ligament  resembles  the  anterior,  but  is 
much  less  distinct,  and  connects  the  bones  posteriorly. 

The  superior  pubic  ligament  connects  the  bones  superiorly. 

The  sub-pubic  ligament,  forming  the  upper  boundary  of 
the  pubic  arch,  is  a  thick  triangular  arch  of  fibres,  attached 
above  to  the  fibro-cartilage,  and  laterally  to  the  rami. 

The  fibro-cartilage  consists  of  two  parts,  one  on  each  bone  ; 
the  two  are  united  in  front,  but  posteriorly  they  are  separated 
by  a  small  cavity  lined  by  a  synovial  membrane. 

ARTICULATIONS  OF  THE  UPPER  EXTREMITY. 

I. — STERNO-CLAVICULAR   ARTICULATION. 

An  arthrodial  joint  between  the  inner  end  of  the  clavicle 
and  the  ist  piece  of  sternum  and  ist  costal  cartilage,  con- 
nected together  by  the  following  ligaments : 

The  anterior  sterno-clavicular  ligament  is  attached  to  upper 
and  anterior  part  of  the  inner  end  of  the  clavicle,  and  to  the 
upper  and  anterior  part  of  the  ist  piece  of  the  sternum. 

The  posterior  sterno-clavicular  ligament  passes  between 
the  inner  end  of  the  clavicle  and  the  sternum  on  the  posterior 
surface. 

The  interclavicular  ligament  passes  along  the  top  of  the 
sternum  from  the  inner  end  of  one  clavicle  to  the  other. 


ARTICULATIONS  9 

The  costo-clavicular  or  rhomboid  ligament :  a  strong  band 
of  fibres  passing  backwards,  upwards,  and  outwards  from  the 
upper  surface  of  the  sternal  end  of  ist  costal  cartilage,  to  a 
rough  marking  on  the  under  surface  of  the  inner  end  of  the 
clavicle. 

The  interarticular  fibro-cartilage  is  a  nearly  circular  plate, 
thicker  at  the  circumference  than  in  the  centre.  It  is  attached 
above  to  the  upper  border  of  the  clavicle,  and  below  to  the  ist 
costal  cartilage  at  its  junction  with  the  sternum.  There  are 
two  synovial  membranes,  one  on  each  side  of  the  cartilage. 

II. — SCAPULO-CLAVICULAR   ARTICULATION. 

(a)  Acrormo-clavicular,  an  arthrodial  joint  held  together  by 
the  following  ligaments  : — 

The  superior  acromio-clavicular  ligament  passes  between 
the  outer  end  of  the  clavicle  and  the  upper  surface  of  the 
acromion. 

The  inferior  acromio-clavicular  ligament  covers  the  joint 
below,  being  attached  to  the  clavicle  internally,  and  the  acro- 
mion externally. 

An  interarticular  fibro-cartilage,  rarely  complete,  usually 
occupies  the  upper  half  of  the  joint.  When  it  is  complete, 
there  are  two  synovial  membranes. 

(ft)  The  toraco-clavicular  ligaments  connect  the  clavicle  and 
the  coracoid  process  of  the  scapula  ;  they  are  : — 

The  trapezoid  ligament  (the  anterior  and  external  one)  : 
attached  below  to  the  posterior  half  of  the  upper  surface  of 
the  coracoid  process,  and  above  to  the  oblique  line  on  the 
under  service  of  the  clavicle.  It  is  in  contact  posteriorly 
with  the  conoid  ligament. 

The  conoid  ligament  (the  posterior  and  internal  one)  is 
attached  above  by  its  base,  to  the  conoid  tubercle  on  the 
inferior  surface  of  the  clavicle,  and  the  contiguous  part ;  by 
its  apex  to  a  rough  depression  at  the  base  of  the  coracoid 
process. 

III.— PROPER   SCAPULAR   LIGAMENTS. 

The  coraco-acromial  ligament  passes  over  the  shoulder- 
joint  between  the  coracoid  and  acromion  processes.  Ex- 
ternally it  is  attached  to  the  tip  of  the  acromion,  and  internally 
to  all  the  outer  border  of  the  coracoid  process. 

The  transverse  or  suprascapular  ligament  stretches  over 
the  notch  on  the  upper  border  of  the  scapula,  and  converts 
it  into  a  foramen. 


10  THE  POCKET  ANATOMY 


IV. — THE    SHOULDER-JOINT. 

This  joint  between  the  head  of  the  humerus  and  the  glenoid 
cavity  is  an  enarthrodial  or  ball-and-socket  joint.  The  long 
tendon  of  the  biceps  acts  as  a  ligament  to  this  joint. 

The  capsular  ligament  is  attached  to  the  circumference  of 
the  glenoid  cavity,  and  to  the  neck  (anatomical)  of  the 
humerus.  It  is  very  loose,  and  permits  free  movement  of  the 
joint.  There  is  generally  an  aperture  on  the  inner  side, 
through  which  a  piece  of  the  synovial  pouch  protrudes  to 
form  the  bursa  under  the  subscapularis. 

The  coraco  humeral  or  accessory  ligament  helps  to 
strengthen  the  capsule ;  it  is  attached  to  the  outer  border 
and  base  of  the  coracoid  process,  and  below  to  the  neck  of 
humerus,  above  great  tuberosity,  and  it  blends  with  the  cap- 
sule at  the  margins  of  the  bicipital  groove. 

Gleno-humeral  ligaments,  seen  as  three  folds  on  inner  aspect 
of  joint :  — 

The  superior  or  Flood's  ligament  passes  along  inner  edge  of 
biceps  tendon  from  glenoid  ligament  to  depression  on  lesser 
tuberosity  at  inner  margin  of  the  bicipital  groove. 

Middle :  oblique,  arises  with  superior,  runs  downwards 
forming  lower  margin  of  aperture  for  subscapularis  bursa 
to  lesser  tuberosity. 

The  inferior  or  Schlemm's  ligament  passes  from  the  lower 
part  of  the  glenoid  cavity  to  the  neck  of  humerus  on  the 
inner  side  of  the  small  tuberosity. 

The  glenoid  ligament  is  a  dense  fibrous  band  attached 
to  the  edge  of  the  glenoid.  cavity  to  deepen  it,  and  is  con- 
tinuous with  tendon  of  the  long  head  of  the  biceps. 

Transverse  over  bicipital  groove. 

A  synovial  membrane  lines  the  joint,  and  protrudes  to  form 
the  bursa  under  the  subscapularis.  It  is  reflected  round  the 
tendon  of  the  biceps,  and  lines  the  bicipital  groove. 

Subacromial  bursa  beneath  acromion  and  deltoid,  and  over 
supraspinatus  and  capsule. 

V. — THE  ELBOW-JOINT. 

The  elbow  is  a  ginglymus  or  hinge-joint,  between  the 
trochlear  surface  of  the  humerus  and  the  greater  sigmoid 
cavity  of  the  ulna,  combined  with  an  arthrodial  joint  between 
the  capitellum  of  the  humerus  and  the  upper  end  of  the 
radius. 

The  anterior  ligament  is  attached,  above  to  the  front  of 


ARTICULATIONS  i, 

the  humerus  just  above  the  coronoid  fossa  ;  and  below  to  the 
coronoid  process,  and  the  front  of  orbicular  ligament. 

The  posterior  ligament  is  attached,  above  to  the  upper 
border  of  the  olecranon  fossa ;  below,  to  the  margin  of  the 
olecranon. 

The  internal  lateral  ligament  is  triangular  in  shape  ;  it  is 
attached,  above  to  the  inner  condyle  of  the  humerus ;  the 
fibres  diverge  as  they  descend,  the  anterior  ones  going  to  the 
inner  margin  of  the  coronoid  process,  the  posterior  to  the 
inner  margin  of  the  olecranon. 

The  external  lateral  ligament,  smaller  than  the  preceding, 
is  attached,  above  to  a  depression  below  the  external  condyle, 
and  below  to  the  orbicular  ligament,  some  of  the  fibres  being 
prolonged  to  the  outer  edge  of  the  ulna. 

The  synovial  membrane  is  very  large,  covering  the  articular 
surfaces  of  the  humerus,  ulna,  and  radius ;  it  also  serves  for 
the  upper  radio-ulnar  articulation. 

VI. — THE    RADIO-ULNAR  ARTICULATIONS. 

(a)  Superior  Radio-ulnar  Articulation  (lateral  ginglyinus). 
The  orbicular  ligament  surrounds  the  head  of  the  radius. 

It  is  attached  to  the  two  ends  of  the  lesser  sigmoid  cavity, 
and  is  wider  above  than  below.  The  outer  surface  is  con- 
nected with  the  external  lateral  ligament.  The  internal 
surface  is  lined  with  synovial  membrane  continuous  with 
that  of  the  elbow-joint. 

(b)  Middle  Radio-ulnar  Articulation. 

The  oblique  or  round  ligament  is  a  fibrous  cord  passing 
downwards  and  outwards  from  the  tubercle  at  the  base  of  the 
coronoid  process,  to  a  little  below  the  tubercle  of  the  radius. 

The  interosseous  membrane  passes  downwards  and  inwards 
(the  opposite  to  the  preceding)  from  the  radius  to  the  ulna  ; 
it  is  attached  to  the  interosseous  border  of  each  bone. 

(c)  Inferior  Radio-ulnar  Articulation  (lateral  ginglymus). 
The  anterior  radio  ulnar  ligament  passes  from  the  anterior 

edge  of  the  radial  sigmoid  cavity  to  the  anterior  surface  of 
the  head  of  ulna. 

The  posterior  radio-ulnar  ligament  extends  similarly  upon 
the  posterior  surface. 

The  triangular  fibro  cartilage  passes  transversely  beneath 
the  lower  end  of  the  ulna,  between  its  styloid  process  and  the 
radius.  Its  apex  is  attached  to  the  outer  side  of  base  of  the 
styloid  process  of  ulna,  and  the  base  to  the  edge  of  the  radius 
between  the  sigmoid  cavity  and  the  lower  articular  surface. 


12  THE  POCKET  ANATOMY 

The  synovial  membrane  (membrana  sacciformis)  is  very  loose, 
and  lines  the  contiguous  surfaces  of  the  radius  and  ulna, 
together  with  the  upper  surface  of  the  triangular  cartilage ; 
sometimes  communicates  with  the  synovial  sac  of  wrist-joint. 

,'   ' 

VII. — THE   WRIST-JOINT. 

The  wrist-joint  is  a  condyloid  joint,  formed  by  the  lower 
end  of  the  radius  and  the  triangular  fibro-cartilage  above ; 
and  by  the  scaphoid,  semilunar  and  cuneiform  bones  below. 
It  is  united  by  the  following  ligaments  : — 

The  external  lateral  ligament  passes  from  the  tip  of  the 
styloid  process  of  the  radius  to  a  depression  on  the  outer 
surface  of  the  scaphoid  bone. 

The  internal  lateral  ligament,  a  fibrous  cord,  passes  from 
the  end  of  the  styloid  process  of  the  ulna,  and  dividing  into 
two,  one  part  is  attached  to  the  pisiform  bone,  and  the  other 
to  the  inner  side  of  the  cuneiform  bone. 

The  anterior  ligament,  broad  and  membranous,  consists  of 
three  bundles  of  fibres,  springing  from  the  anterior  edge  of 
the  lower  end  of  radius,  and  the  styloid  process  of  the  ulna ; 
below  it  is  fixed  into  the  anterior  surfaces  of  the  scaphoid, 
semilunar  and  cuneiform  bones,  some  fibres  being  continued 
to  the  os  magnum. 

The  posterior  ligament,  weaker  than  the  preceding,  springs 
from  the  posterior  margin  of  the  lower  end  of  the  radius,  and 
is  attached  to  the  dorsal  surfaces  of  the  scaphoid,  semilunar, 
and  cuneiform  bones. 

A  synovial  membrane  lines  the  joint. 

VIII. — ARTICULATIONS   OF   THE    CARPUS. 

Articulations  of  the  ist  Row  of  Carpal  Bones,  the  pisiform 
excepted  (arthrodial) . 

The  dorsal  ligaments  pass  transversely  between  the  scaphoid 
and  semilunar,  the  semilunar  and  the  cuneiform. 

The  palmar  ligaments  connect  the  bones  similarly  upon  the 
anterior  surface. 

The  interosseous  ligaments  (2)  close  the  upper  part  of  the 
intervals  between  the  scaphoid  and  semilunar,  the  semilunar 
and  cuneiform  bones. 

Articulations  of  the  2nd  Row  of  Carpal  Bones  (arthrodial). 

The  dorsal  ligaments  (3)  pass  transversely  from  bone  to 
hone  as  in  the  ist  row. 

The  palmar  ligaments  (3),  similar  to  those  of  the  ist  row 


ARTICULATIONS  13 

The  interosseoue  ligaments  (3)  are  thicker  than  those  of 
the  ist  row,  and  connect  the  os  magnum  and  the  trapezoid, 
the  os  magnum  and  the  unciform  bones  and  the  trapezium 
and  trapezoid. 

A  rticulations  of  the  two  Rows  of  Carpal  Bones  together. 

The  anterior  or  palmar  ligaments  pass  from  the  front  of 
the  ist  row  to  the  palmar  surface  of  the  os  magnum. 

The  posterior  or  dorsal  ligaments  are  similarly  placed  upon 
the  dorsal  surface. 

The  lateral  ligaments :  the  external  connects  the  scaphoid 
and  trapezium  bones ;  the  internal  the  cuneiform  and  unciform. 

The  synovial  membrane  is  large  ;  it  lines  the  under  surface 
of  the  bones  of  the  ist  row,  except  the  pisiform  bone,  and  is 
reflected  between  their  contiguous  surfaces;  it  then  passes 
between  the  bones  of  the  2nd  row,  and  lines  their  contiguous 
surfaces,  usually  giving  reflections  between  the  carpal  ends 
of  the  four  inner  metacarpal  i bones,  and  between  the  con- 
tiguous surfaces  of  the  trapezium  and  2nd  metacarpal  bone. 

The  pisiform  bone  is  connected  to  the  cuneiform  by  a  thin 
capsule  lined  by  a  synovial  membrane  ;  and  inferiorly  to  the 
unciform  and  5th  metacarpal  bones. 

The  anterior  annular  ligament  extends  from  the  trapezium 
and  scaphoid  across  to  the  unciform  process  and  pisiform 
bone. 

The  posterior  annular  ligament  extends  from  the  outer 
border  of  lower  end  of  radius,  to  inner  side  of  cuneiform  and 
pisiform  bones. 

IX. — CARPO-METACARPAL   ARTICULATION. 

The  Articulation  of  the  Trapezium  and  ist  Metacarpal. 

Reciprocal  reception  joint. 

The  capsular  ligament,  thick  and  loose,  passes  from  the 
upper  end  of  the  ist  metacarpal  to  the  rough  edge  round  the 
articular  surface  of  the  trapezium.  It  is  lined  by  a  separate 
synovial  membrane. 

Articulations  of  the  Carpus  and  the  rest  of  the  Metacarpus. 

The  dorsal  ligaments  connect  the  carpal  with  the  meta- 
carpal bones  on  the  posterior  surface ;  each  metacarpal 
receives  two  fasciculi,  except  the  5th,  which  has  only  one. 

The  palmar  ligaments  are  similarly  arranged  on  the  anterior 
surface,  except  that  the  3rd  metacarpal  has  three  fasciculi. 

The  interosseous  ligaments  connect  the  os  magnum  and 
unciform  bones  to  the  3rd  and  4th  metacarpal  bones. 

The  synovial  membrane  is  continuous  with  that  between 
;he  two  rows  of  carpal  bones,  and  has  been  described  above. 


14  THE  POCKET  ANATOMY 

Articulations  of  the  Metacarpal  Bones  with  each  other. 

The  carpal  ends  are  united  by  dorsal  and  palmar  ligaments 
passing  transversely. 

The  interosseous  ligaments  pass  between  the  bones  beneath 
the  level  of  the  articular  facets.  The  synovial  membrane  is  con- 
tinuous with  that  between  the  two  rows  of  carpal  bones. 

The  digital  extremities  of  the  four  inner  metacarpals  are 
connected  by  the  transverse  metacarpal  ligament,  which  blends 
with  the  palmar  surface  of  each  metacarpo-phalangeal  articu- 
lation. 

X. — METACARPO-PHALANGEAL  ARTICULATIONS. 

Condyloid  joint. 

The  palmar  ligament  is  a  thick  plate  of  fibro-cartilage,  at- 
tached to  the  head  of  the  metacarpal  bone  and  the  base  of  the 
ist  phalanx  :  laterally  it  blends  with  the  lateral  ligaments. 

The  lateral  ligaments,  one  on  each  side,  attached  above  to 
the  posterior  tubercle  and  depression  on  the  side  of  the  head 
of  the  metacarpal  bone,  and  below  to  the  side  of  the  ist 
phalanx. 

A  synovial  membrane  lines  the  joint. 

XI. ARTICULATIONS   OF    THE    PHALANGES. 

Each  of  these  is  a  small  ginglymus  or  hinge  joint,  con- 
nected by  a  palmar  and  two  lateral  ligaments,  and  lined  by 
a  synovial  membrane. 

ARTICULATIONS  OF  THE  LOWER  LIMB. 

I. — THE    HIP-JOINT. 

This  is  an  enarthrodial  joint,  formed  by  the  head  of  the 
femur  and  the  acetabulum.  The  ligaments  are : — 

The  capsular  ligament,  very  strong  and  fibrous,  arises 
above  from  the  rim  of  the  acetabulum,  just  external  to  the 
cotyloid  ligament,  and  from  the  transverse  ligament  as  it 
bridges  the  cotyloid  notch  :  below  it  is  attached  to  the  neck 
of  the  femur,  in  front  to  the  anterior  intertrochanteric  line, 
superiorly  to  the  root  of  the  neck,  and  posteriorly  to  the 
middle  of  the  neck  of  the  bone,  where  many  of  its  fibres  are 
reflected  upwards  upon  the  neck  as  the  retinacula.  The  fibres 
are  circular  and  longitudinal.  The  circular  are  most  distinct 
at  the  lower  and  posterior  part,  forming  a  collar  at  the  lower 
and  back  part  of  the  joint,  known  as  the  zona  orbicularis.  The 
longitudinal  fibres  form  thick  bands  known  as  accessory  liga- 
ments. There  is  often  an  opening  in  front  of  the  capsule  for 


ARTICULATIONS  15 

*  a  protrusion  of  the  synovial  membrane  to  form  the  bursa  under 
the  psoas. 

The  ilio-femoral  ligament  ( Y  ligament  of  Bigelow]  is  accessory 
to  the  capsule.  It  is  attached  above  to  the  anterior  inferior 
iliac  spine,  and  below  it  bifurcates  and  is  attached  to  the 
anterior  intertrochanteric  line  at  its  outer  and  inner  parts. 

Ischio-capsular  ligament  (accessory),  from  ischium  below 
acetabulum,  to  the  circular  fibres  at  the  lower  and  back  part 
of  the  capsule. 

Pubo-femoral  ligament  (accessory)  passes  from  the  ilio- 
pectineal  eminence  to  the  rough  tubercle  in  front  of  the 
trochanter  minor. 

The  ligamentum  teres  passes  from  the  depression  on  the 
head  of  the  femur  and  spreads  out  to  be  attached  to  the 
margins  of  the  rough  depression  at  the  bottom  of  the  aceta- 
bulum. It  consists  of  connective  tissue  and  vessels,  covered 
with  a  reflection  of  synovial  membrane. 

The  cotyloid  ligament,  a  dense  fibre-cartilaginous  rim, 
prismatic  on  section,  is  attached  to  the  edge  of  the  aceta- 
bulum,  and  to  the  transverse  ligament. 

The  transverse  ligament  is  a  narrow  band  which  crosses 
the  cotyloid  notch ;  the  nutrient  vessels  to  the  joint  pass 
under  it. 

The  synovial  membrane  is  single,  and  is  reflected  over  the 
inner  surface  of  the  capsule  on  to  the  neck  of  the  femur,  thence 
over  the  ligamentum  teres  to  the  bottom  of  the  acetabulum, 
where  it  loosely  covers  some  fat.  (Frequently  communicates 
with  bursa  under  ilio-psoas  tendon.) 

II. — THE    KNEE-JOINT. 

This  is  a  ginglymus,  and  is  formed  by  the  condyles  of  the 
femur,  the  head  of  the  tibia,  and  the  patella. 

The  anterior  or  ligamentum  patellae  is  the  continuation  of 
the  tendon  of  the  quadriceps  extensor.  Above  it  arises  from 
the  apex  and  rough  marking  on  the  lower  and  posterior  sur- 
face of  the  patella  ;  below  it  is  attached  to  the  lower  part  of 
the  tubercle  of  the  tibia.  There  is  a  bursa  between  the  upper 
part  of  the  tubercle  and  the  ligament. 

The  posterior  ligament  (ligamentum  posticum  Winslowii], 
broad  and  thin,  covers  the  back  of  the  joint :  it  springs  above 
from  the  femur  above  the  condyles,  and  is  attached  below  to 
the  head  of  the  tibia.  From  the  semi-membranosus  tendon 
it  receives  a  strong  expansion,  which  passes  superficially 
from  the  inner  tuberosity  of  the  tibia  to  the  inner  side  of  the 
upper  part  of  the  outer  condyle  of  the  femur. 


16  THE  POCKET  ANATOMY 

The  internal  lateral  ligament,  broad  and  flat,  is  attached 
above  to  the  inner  condyle  of  the  femur  ;  below  to  the  margin 
of  the  inner  tuberosity,  and  to  the  inner  surface  of  the  shaft 
of  the  tibia  for  i£  inches. 

The  long  external  lateral  ligament,  a  rounded  cord,  is 
attached  above  to  the  external  condyle  of  the  femur,  and 
below  to  the  external  part  of  the  head  of  the  fibula,  dividing 
the  biceps  tendon  into  two  parts,  a  bursa  intervening. 

The  short  external  lateral  ligament,  very  indistinct,  lies 
parallel  and  behind  the  preceding,  attached  above  to  the 
outer  condyle  of  the  femur,  and  below  to  the  styloid  process 
of  the  fibula. 

The  capsular  ligament,  thin,  fills  up  the  intervals  between 
the  special  ligaments  ;  it  is  attached  to  the  margins  of  the 
articular  surfaces  of  the  bones,  and  blends  with  the  fascia 
lata  of  the  thigh  :  above  it  receives  expansions  from  the  vasti 
(lateral  patellar  ligaments). 

Inter  articular  Structures : — 

The  anterior  or  external  crucial  ligament  is  attached  to 
the  depression  in  front  of  the  spine  of  the  tibia  and  to  the 
external  semilunar  fibro-cartilage ;  it  passes  upwards,  back- 
wards, and  outwards  to  the  posterior  part  of  the  inner  side  of 
the  external  condyle  of  the  femur. 

The  posterior  or  internal  crucial  ligament  is  attached  to  a 
depression  behind  the  spine  of  the  tibia,  to  the  popliteal 
notch,  and  the  posterior  border  of  external  semilunar  fibro- 
cartilage,  this  latter  slip  being  sometimes  called  the  ligament 
of  Wrisberg ;  it  passes  upwards,  forwards,  and  inwards,  the 
posterior  fibres  attached  by  side  of  oblique  curve  of  inner  con- 
dyle, the  anterior  ones  to  fore  part  of  intercondylar  fossa  and 
to  the  anterior  part  of  the  outer  surface  of  the  inner  condyle. 

The  semilunar  cartilages  are  thicker  at  the  circumferences 
than  at  the  central  margins,  and  serve  to  deepen  the  cavities 
for  the  head  of  the  femur. 

The  internal  semilunar  cartilage  is  oval  in  shape,  the 
antero-posterior  diameter  being  the  longer.  Its  anterior  ex- 
tremity is  attached  to  the  tibia  in  front  of  the  anterior  crucial 
ligament,  and  the  posterior  extremity  in  front  of  the  posterior 
crucial  ligament. 

The  external  semilunar  cartilage  is  nearly  circular :  its 
anterior  extremity  is  attached  to  the  tibia  in  front  of  the 
spine,  the  posterior  extremity  to  the  back  of  the  spine. 

In  shape  the  cartilages  may  be  described  thus :  the  internal 
as  a  smaller  segment  of  a  larger  circle,  and  the  external  as  a 
larger  segment  of  a  smaller  circle. 


ARTICULATIONS  17 

Structures  on  the  Head  of  the  Tibia  in  the  middle  line  from 
before  backwards : — 


1.  Transverse  ligament. 

2.  Anterior    extremity   of   in- 

ternal semilunar  cartilage. 

3.  Anterior  crucial  ligament. 

4.  Anterior   extremity   of  ex- 

ternal semilunar  cartilage. 


5.  The  spine  of  tibia. 

6.  Posterior  extremity  of  ex- 

ternal semilunar  cartilage. 

7.  Posterior  extremity  of  in- 

ternal semilunar  cartilage. 

8.  Posterior  crucial  ligament. 


The  transverse  ligament  is  a  band  of  fibres  which  passes 
between  the  anterior  extremities  of  the  semilunar  cartilages. 

The  coronary  ligaments  bind  down  the  circumferences  of 
the  semilunar  cartilages  to  the  head  of  the  tibia. 

The  synovial  membrane  is  the  largest  in  the  body.  It  ex- 
tends 2  inches  above  the  articular  end  of  femur  under  the 
extensors  ;  thence  it  passes  over  the  crucial  ligaments  to  the 
head  of  the  tibia,  where  it  covers  both  surfaces  of  the  semi- 
lunar  cartilages,  and  lastly  it  lines  the  capsule.  It  also  gives 
a  covering  to  the  popliteus  tendon,  where  it  lies  within  the 
capsule,  and  usually  communicates  with  a  bursa  under  the 
inner  tendon  of  the  gastrocnemius  and  between  this  tendon 
and  that  of  the  semi-membranosus. 

The  ligamentum  mucosum  is  a  triangular  fold  of  the 
synovial  membrane,  attached  to  the  intercondyloid  notch, 
and  reaching  to  the  patella. 

The  ligamenta  alaria  are  two  fringes  of  the  synovial  mem- 
brane, seen  on  either  side  of  the  ligamentum  mucosum. 

III. — THE    TIBIO-FIBULAR   ARTICULATIONS. 

(a)  The  Superior  Tibio-fibular  Articulations  (arthrodial). 
The  anterior  superior  ligament  passes  from  the  head  of 

the  fibula  upwards  and  inwards  to  the  external  tuberosity  of 
the  tibia. 

The  posterior  superior  ligament  passes  from  the  back  part 
of  the  head  of  the  fibula  to  the  back  part  of  the  external 
tuberosity  of  the  fibula. 

A  synovial  membrane  lines  the  joint. 

(b)  The  Middle  Tibio-fibular  A  rticulation  consists  of  the  inter- 
osseous  membrane,  the  fibres  passing  down  from  the  tibia 
to  the  fibula,  being  attached  to  the  interosseous  ridges  on  the 
bones.     Superiorly,  there  is  an  opening  for  the  anterior  tibial 
vessels  ;  and  inferiorly,  one  for  the  anterior  peroneal  vessels. 

(c)  The  Inferior  Tibio-fibular  Articulation. 

The  inferior  interosseous  ligament  passes  between  the 
contiguous  rough  surfaces  of  the  tibia  and  fibula,  and  is  con- 
tinuous above  with  the  interosseous  membrane. 


1 8  THE  POCKET  ANATOMY 

The  anterior  ligament  is  triangular  in  shape,  and  passes' 
between  the  adjacent  margins  of  the  tibia  and  fibula. 

The  posterior  ligament  is  similarly  placed  upon  the  posterior 
part  of  the  articulation. 

The  transverse  or  inferior  ligament  lies  deep  to  the  pre- 
ceding, passing  transversely  across  the  back  of  the  joint,  from 
(lie  external  malleolus  nearly  to  the  internal  malleolus,  and 
s  jrves  to  deepen  the  ankle-joint. 

The  synovial  membrane  is  continuous  with  that  of  the 
ankle-joint. 

IV. — THE    ANKLE-JOINT. 

This  is  a  ginglymus  or  hinge  joint ;  the  lower  ends  of  the 
nbia  and  fibula  embracing  the  upper  articular  surface  of  the 
astragalus. 

The  anterior  ligament,  broad  and  thin,  is  connected  above 
with  the  edge  of  the  articular  surface  of  the  tibia,  and  below 
with  the  margin  of  the  superior  articular  surface  of  the  astra- 
galus. 

The  posterior  ligament  consists  principally  of  transverse 
fibres,  which  blend  above  with  the  transverse  ligament  of  the 
inferiortibio-fibular  articulation,  and  are  attached  to  the  back 
part  of  the  upper  articular  surface  of  the  astragalus. 

The  internal  lateral  or  deltoid  ligament  consists  of  two 
parts.  The  superficial  part  is  attached  by  its  apex  to  the 
internal  malleolus,  and  by  its  base  posteriorly  to  the  inner 
side  of  the  astragalus,  the  sustentaculi  tali,  and  anteriorly  to 
the  tuberosity  of  the  scaphoid,  blending  with  the  inferior 
calcaneo-scaphoid  ligament.  The  deep  part  passes  from  the 
apex  of  the  inner  malleolus  to  the  inner  side  of  the  astragalus. 

The  external  lateral  ligament  consists  of  three  bundles  of 
fibres.  The  anterior  slip  passes  between  the  front  of  the 
external  malleolus  and  the  side  of  the  astragalus  in  front  of 
the  superior  articular  process.  The  middle  passes  from  the 
apex  of  the  outer  malleolus  to  the  middle  of  the  outer  side  of 
the  os  calcis.  The  posterior  is  attached  to  the  bone  just  behind 
the  deep  groove  on  the  posterior  part  of  the  outer  malleolus, 
running  transversely  inwards  to  a  depression  on  the  posterior 
surface  of  the  astragalus. 

The  synovial  membrane  lines  the  inner  surface  of  the 
ligaments,  and  is  reflected  on  to  the  articular  surfaces  of" 
the  bones.  It  also  lines  the  inferior  tibio-fibular  articula- 
tion. 


ARTICULATIONS  19 

V. — ARTICULATIONS    OF   THE    TARSUS. 

These  are  arthrodial  joints. 

Articulations  between  the  Cakanewn  and  Astragalus. 

There  are  two  articulations  between  the  calcaneum  and  the 
astragalus :  a  posterior  one,  peculiar  to  the  two  bones,  and 
an  anterior  one,  common  to  them  and  the  scaphoid  bone ; 
they  are  separated  by  the  interosseous  ligament. 

The  external  calcaneo-astragaloid  ligament  passes  from 
outer  surface  of  the  astragalus  just  below  the  external  malle- 
olus,  to  the  outer  surface  of  the  os  calcis. 

The  posterior  calcaneo-astragaloid  ligament  connects  the 
posterior  parts  of  the  two  bones. 

The  interosseous  ligament  consists  of  a  strong  thick  band 
passing  from  the  groove  between  the  articulating  surfaces  of 
the  astragalus  to  a  corresponding  groove  on  the  os  calcis. 

Articulation  between  Calcaneum  and  Scaphoid. 

The  superior  calcaneo-scaphoid  ligament  arises  from  the 
groove  between  the  astragalus  and  os  calcis,  being  blended 
here  with  the  internal  calcaneo-cuboid  ligament,  and  passes 
upwards  and  inwards  to  the  outer  side  of  the  scaphoid  bone. 

The  inferior  calcaneo-scaphoid  is  a  broad  strong  band 
passing  from  the  anterior  and  inner  end  of  the  sustentaculum 
tali  of  the  os  calcis  to  the  hollow  on  the  under  surface  of 
the  scaphoid  bone.  It  supports  the  head  of  the  astragalus, 
and  its  plantar  surface  is  in  contact  with  the  tendon  of  the 
tibialis  posticus. 

_  Articulation  between  the  astragalus  and  scaphoid.     The  only 
ligament  is 

The  superior  astragalo-scaphoid,  passing  from  the  neck  of 
the  astragalus  to  the  upper  surface  of  the  scaphoid  bone. 

Articulations  between  the  Scaphoid,  Cuboid,  and  Three  Cuneiform 
Bones  are  connected  by  the  following  ligaments : 

Dorsal  ligaments,  which  pass  from  one  bone  to  the  other. 

Plantar  ligaments,  similarly  arranged  upon  the  sole. 

Interosseous  ligaments  (4),  strong  fibres  passing  between 
the  rough  non-articulating  surfaces  of  the  bones. 

Articulation  between  Calcaneum  and  Cuboid. 

The  superior  calcaneo-cuboid  ligament  passes  between  the 
dorsal  surfaces  of  the  os  calcis  and  cuboid  bones. 

The  internal  calcaneo-cuboid  or  interosseous  ligament 
attached  to  a  deep  groove  on  the  os  calcis  between  it  and  the 
astragalus,  here  blending  with  the  superior  calcaneo-scaphoid 
ligament,  and  passing  to  the  inner  side  of  the  cuboid  bone. 

The  Inferior  ligaments  are  two  :  — 

The  long  calcaneo-cuboid  (long  plantar)  ligament,  attached 

2—2 


20  THE  POCKET  ANATOMY 

to  the  under  surface  of  the  os  calcis  in  front  of  the  tuberosities  ; 
it  passes  to  the  posterior  margin  of  the  peroneal  groove  of  the 
cuboid  ;  some  of  the  fibres  arch  over  the  sheath  of  the  tendon, 
and  are  attached  to  the  bases  of  the  and,  3rd  and  4th  meta- 
tarsal  bones. 

The  short  calcaneo-cuboid  ligament  is  more  deeply  placed  , 
it  reaches  from  the  tubercle  and  depression  on  the  under 
surface  of  the  os  calcis  to  the  under  surface  of  the  cuboid 
behind  the  peroneal  groove. 

VI . — T ARSO-METATARSAL   ARTICULATIONS. 

The  metatarsal  bones  are  connected  to  the  tarsus  by : — 

Dorsal  ligaments,  one  to  each  metatarsal  bone  from  the 
tarsal  bone  it  articulates  with.  The  2nd  metatarsal  has  a 
slip  from  each  cuneiform  bone. 

The  plantar  ligaments,  disposed  irregularly. 

The  interosseous  ligaments,  strong  bands,  three  in  number. 
The  internal  one  passes  from  internal  cuneiform  to  the  2nd 
metatarsal.  The  middle  one  passes  between  the  external 
cuneiform  and  the  2nd  metatarsal.  The  external  connects  the 
external  cuneiform  and  the  3rd  metatarsal. 

The  synovial  membranes  of  the  tarsus  and  metatarsus  are 
six  in  number : — 

One  for  the  posterior  calcaneo-astragaloid  articulation. 

One  for  the  anterior  calcaneo-astragaloid  articulation  and 
the  scapho-astragaloid  articulation. 

One  for  the  calcaneo-cuboid  articulation. 

One  for  the  articulations  of  the  scaphoid,  and  the  three 
cuneiform  bones  ;  the  cuneiform  bones  with  each  other  ;  the 
external  cuneiform  and  the  cuboid ;  and  the  middle  and 
external  cuneiform  bones  with  the  bases  of  the  2nd  and  3rd 
metatarsal  bones. 

One  between  ist  metatarsal  and  internal  cuneiform. 

One  for  4th  and  sth  metatarsal  with  cuboid. 

VII. — ARTICULATIONS   OF   THE    METATARSAL   BONES   WITH 
EACH   OTHER. 

The  bases  of  the  metatarsal  bones  are  connected  by  dorsal, 
plantar,  and  interosseous  ligaments. 

The  digital  ends  are  united  by  the  transverse  metatarsal  liga- 
ment, which  on  the  plantar  aspect  connects  the  ist  metatarsal 
with  the  others  (compare  with  hand). 

VIII. — METATARSO-PHALANGEAL    ARTICULATIONS. 

These  articulations  are  precisely  similar  to  the  correspond- 
ing parts  of  the  hand. 


MUSCLES  21 


IX. — ARTICULATIONS    OF   THE    PHALANGES. 

The  preceding  remark  equally  applies  to  these  articula- 
tions. 

THE   MUSCLES. 

Explanation. 

The  —  dash  divides  the  origin  from  the  insertion. 

Nervous  supply  is  indicated  by  (  )  brackets. 

Action  of  muscle  is  indicated  by  [  ]  brackets,  and  if  a  muscle 
has  two  points  on  which  it  acts,  A  applies  to  action  from  origin 
on  point  of  insertion,  and  B  applies  to  action  from  insertion 
on  point  of  origin. 

F  signifies  that  the  attachment  is  fleshy. 

T  ,,  ,,  tendinous. 

A  ,,  ,,  aponeurotic. 

A  combination  of  any  of  these  attachments  may  occur. 

MUSCLES  AND  FASCLE  OF  THE  HEAD  AND 

NECK. 

The  superficial  fascia  in  the  epicranial  region  and  on 
the  face  is  closely  united  to  the  skin,  slightly  developed, 
except  between  bellies  of  occipito-frontalis  muscle.  At  the 
back  part  it  becomes  continuous  with  superficial  fascia  of 
posterior  muscles  of  the  neck,  and  descends  laterally  over  the 
temporal  fascia,  where  it  envelops  the  external  muscles  of 
auricle,  and  the  superficial  temporal  vessels  and  nerves.  In 
the  neck  it  is  loose  and  fatty,  as  over  rest  of  body. 

EPICRANIAL    REGION. 

Occipito-frontalis :  Frontal  part.  Has  no  bony  attach- 
ments, blends  with  orbicularis  palpebrarum,  pyramidalis 
nasi  and  corrugator  supercilii(p) — epicranial  aponeurosis(A) 
(Facial).  Occipital  part.  Outer  §  superior  curved  occi- 
pital lines,  mastoid  processes(FT) — epicranial  aponeurosis, 
which  is  attached  behind  to  curved  line  between  fleshy 
heads(A).  (Posterior  auricular  branch  of  facial.)  [Frontal 
part  wrinkles  forehead  horizontally.  Occipital  part  removes 
the  wrinkles;  acting  alternately  the  two  parts  move 
scalp.] 

Epicranial  aponeurosis  unites  frontal  and  occipital  muscles, 


22  THE  POCKET  ANATOMY 

and  is  also  attached  to  inner  £  of  superior  curved  line  of 
occipital  behind.  Laterally  it  is  lost  over  temporal  fascia, 
where  it  gives  origin  to  attrahens  and  attollens  aurem. 


AURICULAR    REGION. 

Attrahens  aurem  :  fore  part  of  epicranial  aponeurosis(F) — 
fore  part  of  helix,  and  eminence  on  back  of  pinna,  corre- 
sponding to  the  fossa  of  the  antihelix(x)  (Temporal  branch 
of  facial).  [Very  little  ;  draws  ear  forward.] 

Attollens  aurem:  epicranial  aponeurosis(p) — cranial  surface 
pinna,  corresponding  to  fossa  of  antihelix(T)  (Temporal 
branch  of  facial).  [Very  little  ;  raises  ears.] 

Eetrahens  aurem:  root  of  mastoid  process(A)— lower  part 
of  cranial  surface  of  concha(A)  (Posterior  auricular).  [Very 
little  ;  draws  ear  back.] 

PALPEBRAL    REGION. 

Orbicularis  palpebrarum :  Sphincter  of  eyelids.  Orbital  part. 
Internal  angular  process  of  frontal,  internal  tarsal  ligament, 
nasal  process  of  superior  maxilla(F).  Palp ebral  part.  Internal 
tarsal  ligament(F) — external  tarsal  ligament(F) (Facial).  Ciliary 
part.  Marginal  portion  of  preceding  ;  lies  along  bases  of  eye- 
lashes. [Closes  eye ;  maintains  apposition  of  eyelids  to 
eyeball.] 

Tensor  tarsi  (Horner's  muscle) :  ridge  of  os  lachrymalis(F) 
—joins  with  ciliary  part  of  orbicularis  internal  to  the 
punctum(p)  (Facial).  [Acting  with  orbicularis  empties  lach. 
rymal  sac.] 

Internal  tarsal  ligament  (tendo  oculi)  is  attached  to  ridge  on 
nasal  process  of  superior  maxilla  in  front  of  lachrymal 
groove,  divides  into  two  slips,  each  joining  the  inner  end  of 
the  corresponding  tarsal  cartilage. 

External  tarsal  ligament,  connects  the  tarsal  cartilages  to 
outer  part  of  orbit. 

Corrugator  supercilii :  inner  part  of  superciliary  ridge  of 
frontal(F) — under  surface  of  orbicularis,  opposite  middle  of 
orbital  arch(p)  (Facial).  [Wrinkles  forehead  vertically.] 

ORBITAL    REGION. 

Levator  palpebrse  superioris :  inferior  surface  of  small  wing 
of  sphenoid,  anterior  to  foramen  opticum  and  external  to 
superior  oblique(x) — anterior  part  of  superior  tarsal  plate, 
also  superiorly  to  join  orbicularis  and  inferiorly  to  superior 


MUSCLES  23 

fornix  of  conjunctiva(A)  (Upper  division  of  3rd).  [Raises  upper 
eyelid.]  The  four  recti  arise  from  two  common  tendons — 
superior  and  inferior.  Superior  common  tendon  (ligament  of 
Lock  wood)  rises  above  and  outside  optic  foramen  and  gives 
origin  to  superior,  internal  and  external  recti  (upper  head). 
The  inferior  common  tendon  (ligament  of  Zinn)  below  and 
outside  optic  foramen  goes  to  inferior,  internal,  and  lower 
head  of  external  recti. 

Rectus  superior :  upper  margin  of  optic  foramen(T) — 
sclerotic(x)  (Upper  division  of  3rd).  [Rotates  cornea  up- 
wards and  inwards.] 

Rectus  inferior :  margin  of  optic  foramen(T) — sclerotic(x) 
(Lower  division  of  3rd).  [Rotates  cornea  downwards  and 
inwards.] 

Rectus  interims :  optic  foramen(x) — sclerotic(T)  (Lower 
division  of  3rd).  [Rotates  cornea  inwards]. 

Rectus  externus:  Upper  head.  Optic  foramen(T).  Lower 
head.  Optic  foramen  and  process  of  bone  at  the  lower  margin 
of  spheroidal  fissure(x) — sclerotic(x)  (6th).  [Rotates  cornea 
outwards.]  Between  the  two  heads  pass  ^rd,  6th,  nasal  branch  oj 
5/A  nerve  and  ophthalmic  vein. 

Obliquus  superior  :  inner  part  of  optic  foramen(x)— passes 
through  "pulley,"  thence  reflected  backwards  and  outwards 
between  superior  rectus  and  eyeball  to  be  attached  to  scle- 
rotic between  superior  and  external  recti  (x)  (4th).  [Rotates 
cornea  downwards  and  outwards.]  The  qth  nerve  enters  its 
•upper  surface. 

Obliquus  inferior :  depression  on  orbital  plate  of  superior 
maxilla(F)— external  surface  of  sclerotic  under  cover  of 
external  rectus(x).  (Lower  division  of  3rd).  [Rotates  cornea 
upwards  and  outwards.]  Passes  outivards  from  origin  beneath 
inferior  rectus  and  between  eyeball  and  external  rectus  to  its  in- 
sertion. 

NASAL   REGION. 

Pyramidalisnasi :  occipito-frontalis(F) — compressor naris(A) 
(Facial).  [Wrinkles  skin  over  nose.] 

Compressor  naris  :  facial  surface  of  superior  maxilla  by  side 
of  anterior  nares(p)— its  fellow  of  side(A)  (Facial).  [Closes 
anterior  nares.] 

Levator  labii  superioris  alseque  nasi :  root  of  nasal  process 
of  superior  maxilla(F) — ist  slip,  cartilage  of  ala ;  2nd  slip, 
orbicularis  oris(p)  (Facial).  [Raises  ala  of  nose  and  upper  lip.] 

Depressor  al»  nasi  :  incisor  fossa  of  superior  maxilla(F)— 
septum  and  ala  of  nose(p)  (Facial).  [Very  little  ;  depresses 
ala.] 


24  THE  POCKET  ANATOMY 

Dilatator  naris:  Anterior  slip.     Cartilage  of  ala(p) — inner 

border  of  integument  of  ala(p).  Posterior  slip.  Nasal  notch 
of  superior  maxilla(F) — inner  border  of  integument  of  ala(F) 
(Facial).  [Dilates  anterior  nares.] 

SUPERIOR    MAXILLARY    REGION. 

Levator  labii  superioris :  superior  maxilla  and  malar  above 
infra-orbital  foramen (F) — orbicularis  oris(F)  (Facial).  [Raises 
upper  lip.] 

Levator  anguli  oris:  canine  fossa  of  superior  maxilla, 
beneath  infra-orbital  foramen(p) — angle  of  mouth(p)  (Facial). 
[Raises  angle  of  mouth,  as  in  smiling.] 

Zygomaticus  major:  malar  bone  in  front  of  zygoma(p) — 
angle  of  mouth(F)  (Facial).  [Raises  angle  of  mouth.] 

Zygomaticus  minor :  malar  bone  near  maxillary  suture(p) 
—angle  of  mouth(p)  (Facial).  [Raises  angle  of  mouth.] 

INFERIOR    MAXILLARY    REGION. 

Levator  labii  inferioris,  vel  levator  menti :  incisor  fossa  of 
inferior  maxilla(F) — integument  of  chin(p)  (Facial).  [Raises 
skin  of  chin.] 

Depressor  labii  inferioris,  vel  quadratus  menti :  external 
oblique  line  of  inferior  maxilla  from  symphysis  to  mental 
foramen(p) — orbicularis  oris(p)  (Facial).  [Draws  down  lower 
lip,  everting  it.] 

Depressor  anguli  oris,  vel  triangularis  menti :  external 
oblique  line  of  inferior  maxilla(p) — angle  of  mouth  (F)  (Facial). 
[Depresses  angle  of  mouth,  as  in  crying.] 

INTER-MAXILLARY    REGION. 

Orbicularis  oris :  sphincter  of  mouth.  The  labial  part  is  free 
from  attachment  to  bone,  and  forms  red  part  of  lips.  The  outer 
or  facial  part  is  connected  with  the  muscles  which  converge 
to  the  angles  of  the  mouth,  and  is  attached  in  the  upper  lip 
to  septum  nasi  and  incisive  fossa  of  superior  maxilla,  and  in 
the  lower  lip  to  canine  fossa  of  inferior  maxilla(p)  (Facial). 
[Closes  oral  fissure,  producing  radiating  wrinkles.] 

Buccinator:  external  surfaces  of  alveolar  processes  of 
superior  and  inferior  maxillae,  as  far  forwards  as  ist  molar ; 
pterygo-maxillary  ligament(p) — angle  of  mouth  where  fibres 
decussate(p)  (Facial).  [Closes  mouth,  also  prevents  food  col- 
lecting between  teeth  and  lips ;  maintains  tone  of  cheeks,  as 
in  whistling. 


MUSCLES  25 

The  pterygo-maxillary  ligament  extends  from  the  hamular 
process  to  the  posterior  edge  of  the  mylo-hyoid  ridge  of 
inferior  maxilla.  It  separates  buccinator  from  superior  con- 
strictor of  pharynx,  giving  origin  to  both. 

Risorius  :  fascia  covering  masseter(F) — apex  of  depressor 
anguli  oris(F)  (Facial).  [Draws  angle  of  mouth  back.]  (This 
muscle  is  part  of  the  platysma  of  neck.) 

TEMPORO-MAXILLARY   REGION. 

Masseter :  Superficial  part.  Malar  process  of  superior  maxilla. 
Anterior  §  of  lower  border  of  zygoma(TA) — angle  and  lower 
£  of  outer  surface  of  ramus(p).  Deep  part.  Posterior  £  lower 
border  and  inner  surface  of  zygoma  (F) — upper  £  of  ramus 
and  outer  surface  of  coronoid  process(p)  (Inferior  maxillary). 
[Muscle  of  mastication;  elevates  lower  jaw  and  draws  it 
forward.] 

The  masseteric  fascia,  a  continuation  of  the  deep  cervical 
fascia,  is  attached  above  to  the  zygoma;  continuing  back- 
wards it  invests  parotid  gland  (parotid  fascia),  from  the  deep 
surface  of  which  the  stylo-maxillary  ligament  proceeds. 

Temporal:  temporal  fascia  and  fossa(F) — internal  surface 
and  fore  part  of  coronoid  process  of  inferior  maxilla  as  far  as 
last  molar(AT)  (Inferior  maxillary).  [Muscle  of  mastication, 
closing  mouth ;  anterior  fibres  protrude  jaw,  posterior  retract.] 

The  temporal  fascia  is  attached  above  to  the  temporal  ridge, 
and  divides  below  into  two  layers,  which  are  attached  to 
inner  and  outer  edges  of  superior  border  of  zygoma.  It 
covers  the  temporal  muscle,  and  between  the  two  layers  are 
the  temporal  branch  of  temporo-malar  nerve,  and  the  orbital 
branch  of  superficial  temporal  artery. 

PTERYGO-MAXILLARY   REGION. 

External  pterygoid  :  pterygoid  ridge  and  surface  below  on 
great  wing  of  sphenoid,  outer  surface  of  external  pterygoid 
plate(r) — pterygoid  depression  in  front  of  neck  of  inferior 
maxilla  and  inter-articular  fibro-cartilage  of  temporo-maxillary 
joint(p)  (Inferior  maxillary).  [Muscle  of  mastication  ;  both 
acting  together  protrude  lower  jaw :  acting  alternately  cause 
grinding  movements,  each  moving  jaw  to  opposite  side.] 

Between  sphenoidal  and  pterygoid  attachments,  the  internal 
maxillary  artery  dips  down  to  reach  spheno-maxillary  fossa,  and 
the  buccal  and  anterior  deep  temporal  nerves  appear. 

Internal  pterygoid  :  inner  surface  of  external  pterygoid 
plate,  tuberosity  of  palate  bone,  and  tuberosity  of  superior 


26  THE  POCKET  ANATOMY 

maxilla(F) — angle  and  inner  surface  of  ramus  of  inferior 
maxilla(TA)  (Inferior  maxillary).  [Muscle  of  mastication; 
elevates  and  draws  lower  jaw  forward.] 

On  muscle  are  inferior  dental  and  gustatory  nerves,  internal 
maxillary  and  inferior  dental  arteries,  and  internal  lateral  ligament 
of  jaw. 

SUPERFICIAL   CERVICAL   REGION. 

Platysma  myoides  :  clavicle  and  acromion,  fascia  covering 
deltoid,  pectoralis  major,  and  trapezius(p) — Inner  fibres.  Blend 
with  opposite  platysma.  Outer  fibres. — Lower  jaw,  prolonged 
to  angle  of  mouth  and  cheek(p)  (Facial).  [Feeble  depressor 
of  jaw  ;  moves  skin  of  neck  and  maintains  its  contour.]  The 
higher  fibres  of  this  muscle  form  the  risorius. 

Sterno-cleido-mastoid :  Inner  head.  Upper  and  anterior 
part  of  ist  piece  of  sternum(T).  Outer  head.  Inner  ^  of 
superior  surface  clavicle(F)— external  surface  of  mastoid  pro- 
cess from  base  to  apex(i),  and  outer  §  of  superior  curved  line 
of  the  occiput(A)  (Spinal  accessory,  Deep  branch  of  2nd 
cervical).  [(A)  Each  side  acting  alone  rotates  face  to  opposite 
shoulder  and  bends  neck  to  same  side ;  (B)  raises  clavicle, 
and  so  aids  forced  inspiration.] 

Forms  anterior  boundary  of  posterior,  and  posterior  boundary  of 
anterior  triangles  of  neck.  Clavicular  origin  conceals  :  anterior 
scalenus,  omo-hyoid.  Sternal  origin  conceals:  depressors  of 
hyoid  bone,  cervical  lymphatic  glands,  great  cervical  vessels 
and  pneumogastric  nerve.  Union  of  two  heads  conceals :  middle 
scalenus,  levator  anguli  scapulas,  cervical  plexus.  Near  in- 
sertion conceals :  splenius,  trachelo-mastoid,  digastric,  occipital 
artery,  part  of  parotid. 

The  deep  cervical  fascia  is  attached  behind  to  the  superior 
curved  line  of  the  occiput,  to  the  ligamentum  nuchae  and  to 
the  spine  of  yth  cervical  vertebra. 

It  passes  forwards  enclosing  the  trapezius,  and  then  over 
the  posterior  triangle  as  a  single  layer  (where  external  jugular 
vein  pierces  it)  until  it  reaches  the  posterior  border  of  the 
sterno-mastoid,  where  it  divides  into  two  layers  to  enclose 
that  muscle :  in  this  area  it  is  attached  below  to  the  clavicle 
At  the  anterior  border  of  the  sterno-mastoid  the  two  layers 
again  blend  together  (except  for  about  one  inch  above  the 
sternum),  and  passing  forwards,  over  the  anterior  triangle,  it 
blends  with  the  fascia  of  opposite  side  in  the  middle  line. 

Below  where  the  two  layers  do  not  blend  together,  tbe 
anterior  one  is  attached  to  the  front  of  the  upper  part 


MUSCLES  27 

of  the  sternum  and  to  the  interclavicular  ligament,  whilst 
the  posterior  one  is  connected  to  the  posterior  edge  of  the 
upper  part  of  the  same  bone.  A  small  interval  (Burn's  space) 
is  thus  left,  triangular  in  vertical  section  with  the  base  at 
upper  border  of  the  sternum,  which  contains  some  loose 
areolar  tissue,  some  fat,  and  often  a  lymphatic  gland,  with 
the  anterior  jugular  veins. 

Superiorly  this  anterior  layer  passes  over  the  parotid  and 
masseter,  forming  the  parotid,  and  masseteric  fascia,  and  is 
attached  above  and  behind  to  the  lower  border  of  the 
zygoma,  and  below  and  in  front  to  the  lower  edge  of  the 
body  of  the  lower  jaw. 

From  the  posterior  surface  of  the  fascia  covering  the 
anterior  triangle  a  septum  passes  inwards,  separating  the 
submaxillary  and  parotid  glands,  and  forms  the  stylo- 
maxillary  ligament. 

Processes  given  off  from  the  deep  cervical  fascia. 

From  the  layer  passing  behind  the  sterno-mastoid  there 
proceed : — 

1.  A  layer  which  passes  behind  carotid  vessels. 

2.  A  layer  which  passes  in  front  of  carotid  vessels. 
These  two  layers  blend  together  at  the  inner  border  of  the 

carotid  artery,  forming  the  carotid  sheath  to  enclose  carotid 
artery,  internal  jugular,  and  pneumogastric  nerve.  The 
united  layers  pass  upwards  and  inwards  in  front  of  the 
longns  colli  and  behind  the  pharynx  and  O3sophagus,  to  blend 
with  like  process  from  opposite  side  and  form  the  prevertebral 
fascia. 

This  layer  separates  the  prevertebral  muscles  from  the 
pharyngeal  fascia  on  the  pharynx  and  oasophagus  (retro- 
pharyngeal  space  continuous  with  the  posterior  mediastinum) 
and  is  prolonged  laterally  over  the  scaleni,  brachial  plexus,  and 
subclavian  vessels  to  help  form  the  axillary  sheath. 

The  cervical  fascia  is  attached  in  the  middle  line  to  the 
symphysis  menti,  the  hyoid  bone,  and  the  anterior  edge  of 
the  upper  border  of  the  sternum. 

3.  A  layer  in  front  of  thyroid  body  and  trachea,  but  behind 
the  sterno-hyoid  and   thyroid  muscles,  which  joins  with  a 
corresponding  process  of  the  opposite  side,  and  passing  down 
to  the  root  of  the  neck  in  front  of  the  trachea  and  large  vessels, 
blends  with  the  fibrous  layer  of  the  pericardium. 

4.  A  process  to  enclose  the  omo-hyoid  tendon,  which  binds 
it  down  to  the  clavicle  and  first  rib,  blending  with  the  costo- 
coracoid  membrane. 


28  THE  POCKET  ANATOMY 


INFRA-HYOID    REGION. 

Sterno-hyoid :  posterior  surface  of  sternum,  clavicle  and 
intervening  ligament  (F) — lower  border  of  body  of  hyoid  bone 
(A)  (ist,  2nd  and  3rd  cervical  through  ansa  hypoglossi). 
[Depresses  hyoid  bone.] 

Sterno-thyroid  :  posterior  surface  of  sternum,  cartilage  of 
ist  rib(F)— oblique  line  on  side  of  thyroid  cartilage(p)  (ist, 
2nd  and  3rd  cervical  through  ansa  hypoglossi).  [Depresses 
thyroid  cartilage.] 

Thyro-hyoid :  oblique  line  on  side  of  thyroid  cartilage(p) 
— internal  half  of  greater  cornu  and  outer  part  of  body  of 
hyoid  bone(p)  (ist  and  2nd  cervical).  [Depresses  hyoid  on 
thyroid.] 

Omo-hyoid:  upper  border  of  scapula  behind  notch,  and 
transverse  ligament(A) — lower  part  of  body  of  hyoid  bonefp) 
(ist,  2nd  and  3rd  cervical  through  ansa  hypoglossi).  [A  de- 
presses hyoid,  B  very  feebly  raises  shoulder.] 

Consists  of  two  bellies  united  by  an  intervening  tendon.  The 
tendon  and  posterior  belly  is  bound  down  to  clavicle  and  cartilage  of 
ist  rib  by  a  process  of  deep  cervical  fascia. 

SUPRA-HYO1D    REGION. 

Digastric  :  Posterior  belly.  Groove  on  internal  surface  of 
mastoid  process(p).  Anterior  belly.  Posterior  surface  of  in- 
ferior maxilla,  by  side  of  symphysis(p) — intervening  tendon 
(T),  which  is  bound  down  to  hyoid  bone  by  process  of  deep 
cervical  fascia  (anterior,  Mylo-hyoid  of  inferior  dental ; 
posterior,  Facial).  [With  posterior  belly  fixed  and  hyoid 
bone  depressed,  it  depresses  mandible;  with  the  lower  jaw 
fixed,  it  raises  hyoid.] 

Stylo-hyoid :  posterior  aspect  of  styloid  process  near  root(x) 
—body  of  hyoid  bone  at  union  of  great  cornu  and  body(x) 
(Facial) .  [Raises  and  draws  back  hyoid  bone,  and  so  tongue.] 
Perforated  by  tendon  of  digastric. 

Mylo-hyoid  :  mylo-hyoid  ridge  on  inner  surface  of  inferior 
maxilla(F) — middle  of  body  of  hyoid  bone(T),  and  joins  fellow 
in  median  line(A)  (Mylo-hyoid  of  inferior  dental).  [A  raises 
and  draws  forwards  hyoid  under  mandible  ;  B  depresses  jaw.] 

Parts  beneath  the  mylo-hyoid:  sublingual  and  part  of  sub- 
maxillary  gland,  with  Wharton's  duct;  genio-hyoid,  genio- 
hyo-glossus,  hyo-glossus,  stylo-glossus  muscles,  sublingual  and 
ranine  arteries ;  gustatory,  and  hypoglossal  nerves ;  sub- 
maxillary  ganglion . 


MUSCLES  29 

Genio-hyoid :  inferior  genial  tubercle  on  posterior  surface 
of  inferior  maxilla  near  symphysis(T) — middle  of  body  of 
hyoid  bone(p)  (ist  and  2nd  cervical).  [Raises  and  draws 
forward  hyoid.] 

LINGUAL    REGION. 

Genio-hyo-glossus :  superior  genial  tubercle  on  posterior 
surface  of  inferior  maxilla  near  symphysis(T) — body  of  hyoid 
bone(p)  (posterior  fibres) :  inferior  surface  of  tongue  from  root 
to  tip(p)  (anterior  fibres)  (Hypoglossal).  [Raises  tongue  and 
hyoid  bone,  draws  tongue  forwards  and  protrudes  it  to  opposite 
side.] 

Hyo-glossus :  side  of  body,  from  all  great  cornu  of  hyoid 
and  from  smaller  cornu(p) — back  and  side  of  tongue(p)  (Hypo- 
glossal).  [Depresses  sides  of  tongue,  making  surface  convex 
laterally.] 

Parts  beneath  hyo-glossus  :  inferior  lingualis,  genio-hyo-glossKS 
and  middle  constrictor  muscles,  lingual  vessels,  stylo-hyoid 
ligament,  glosso-pharyngeal  nerve. 

Stylo-glossus :  external  surface  of  apex  of  styloid  process 
and  stylo-maxillary  ligament  (A) — dorsum  and  tip  of  tongue(p) 
(Hypoglossal).  [Draws  tongue  upwards  and  backwards,  makes 
Miperior  surface  concave  laterally.] 


PHARYNGEAL    REGION. 

Inferior  constrictor :  side  of  cricoid  cartilage ;  oblique  line 
on  thyroid  and  surface  behind  it,  inferior  cornu  of  thyroid 
cartilage(p)  —  fibrous  raphe  in  posterior  median  line  of 
pharynx(p)  (Pharyngeal  plexus,  External  laryngeal,  Re- 
current laryngeal).  [Squeezes  food  towards  oesophagus  in 
swallowing.  3 

Middle  constrictor  :  great  and  small  cornua  of  hyoid  bone, 
stylo-hyoid  ligament (F) — fibrous  raphe  in  posterior  median 
line  of  pharynx(p)  (Pharyngeal  plexus).  [Squeezes  food 
towards  oesophagus  in  swallowing.]  Superior  laryngeal  vessels 
and  internal  laryngeal  nerve  pass  between  this  muscle  and  the 
inferior,  near  origin. 

Superior  constrictor :  lower  3rd  of  posterior  margin  of  in- 
ternal pterygoid  plate,  hamular  process,  pterygo-maxillary 
ligament,  posterior  part  of  mylo-hyoid  ridge  of  inferior 
maxilla,  mucous  membrane  of  mouth  and  side  of  tongue(F) 
—  fibrous  raphe  in  posterior  median  line  of  pharynx(p),  and 
pharyngeal  spine  on  basilar  process(p)  (Pharyngeal  plexus). 
[Squeezes  food  towards  oesophagus  in  swallowing.]  Internal 


30  THE  POCKET  ANATOMY 

carotid  artery,  pneumogastric  and  sympathetic  nerves,  middle  con- 
stricter  and  stylo-pharyngeus,  etc.,  lie  on  outer  surface. 

Stylo-pharyngeus  :  inner  surface  of  base  of  styloid  pro- 
cess^)—  pharynx  and  posterior  border  of  thyroid  carti- 
lage^) (Glosso-pharyngeal).  [Raises  pharynx  over  food 
in  swallowing.]  Passes  between  external  and  internal  carotid 
arteries. 


PALATAL  REGION. 

Levator  palati  sunder  surface  of  apex  of  petrous  portion  of 
temporal,  lower  margin  of  cartilage  of  Eustachian  tube(T) — 
middle  line  of  soft  palate(p)  (Pharyngeal  plexus).  [Raises 
palate,  shutting  off  naso-pharynx.] 

Tensor  vel  circumflexus  palati :  scaphoid  fossa  of  sphenoid, 
outer  side  of  Eustachian  tube,  spine  of  sphenoid(F)  (turns 
round  hamular  process]  —  posterior  border  of  hard  palate, 
aponeurosis  of  soft  palate(A)  (Otic  ganglion).  [Raises  and 
makes  tense  soft  palate.] 

Azygos  uvulae  :  posterior  nasal  spine  of  palate  bone(p) — tip 
of  uvula(F)  (Pharyngeal  plexus).  [Shortens  uvula.] 

Palato-glossus  (anterior pillar  of  soft  palate]  :  side  and  dorsum 
of  tongue (F)—  anterior  and  lateral  surface  of  soft  palate(p) 
(Pharyngeal  plexus).  [Tends  to  approximate  back  of  tongue 
and  soft  palate.] 

Palatp-pharyngeus  (posterior  pillar  of  soft  palate] :  Anterior 
fibres  join  opposite  muscle  at  middle  line  lying  between  the 
levator  and  tensor.  Posterior  fibres  join  opposite  fellow  at 
middle  line(p)  (Pharyngeal  plexus).  Salpingo-pharyngeus  : 
lower  edge  of  cartilage  of  Eustachian  tube — posterior  border 
of  thyroid  cartilage,  side  of  pharynx(p).  [A  raises  pharynx  ; 
B  will,  with  palato-glossus,  shut  off  mouth  from  naso- 
pharynx.] 

INTRA-LARYNGEAL    REGION. 

Crico-thyroideus  :  lower  cornu  and  lower  border  of  thyroid 
cartilage(p)— front  and  side  of  cricoid  cartilage(p)  (External 
laryngeal).  [Rotates  posterior  part  of  cricoid  downwards  and 
backwards,  and  so  makes  vocal  cords  tense.] 

Thyro-arytenoideus  :  lower  half  of  receding  angle  of  thyroid 
cartilage,  crico-thyroid  membrane(p). — Two  sets  of  fibres. 
Internal,  edge  of  vocal  process(F)— External,  outer  surface  of 
arytenoid  cartilage(p)  (Recurrent  laryngeal).  [Slackens  vocal 
cords.] 


MUSCLES  31 

Crico-arytenoideus  lateralis:  side  of  superior  border  of 
cricoid  cartilage(F) — projection  at  external  angle  of  base  of 
arytenoid  cartilage,  and  contiguous  external  surface(p)  (Re- 
current laryngeal  j.  [Adducts  cords.] 

Cricp  -  arytenoideus  posticus  :  depression  near  ridge  on 
posterior  surface  of  cricoid  cartilage(p) — projection  at  external 
angle  of  base  of  arytenoid  cartilage(p)  (Recurrent  laryngeal). 
[Abducts  cords.] 

Arytenoideus  :  single  muscle  in  the  median  line,  fills  up 
posterior  concave  surface  of  arytenoid  cartilages.  Superficial 
fibres  pass  from  apex  of  one  cartilage  to  base  of  other.  Deep 
fibres  pass  between  posterior  surfaces  of  the  cartilages  (Re- 
current laryngeal).  [Approximates  cords.] 

ANTERIOR   VERTEBRAL   REGION. 

Rectus  capitis  anticus  major:  four  tendinous  slips  from 
anterior  tubercles  of  transverse  processes  of  6th,  5th,  4th,  3rd 
cervical  vertebrae(T) — basilar  process  of  occipital(p)  (ist,  2nd. 
3rd  and  4th  cervical).  [Flexes  head  and  cervical  spine.] 

Rectus  capitis  anticu?j  minor:  root  of  transverse  process 
and  lateral  mass  of  atlas(p) — basilar  process  of  occipital(p) 
(ist  cervical).  [Flexes  head.] 

Rectus  lateralis  :  superior  surface  of  transverse  process  of 
atlas(F)— jugular  process  of  occipital(p)  (ist  cervical).  [Flexes 
head  to  same  side.]  Highest  intertransverse  muscle. 

Longus  colli :  Superior  oblique  part.  Anterior  tubercles  of 
transverse  processes  of  3rd,  4th,  5th  cervical  vertebrae(T) — 
tubercle  on  anterior  arch  of  atlas(T).  Inferior  oblique  part. 
Bodies  of  first  three  dorsal(p)— anterior  tubercles  of  trans- 
verse processes  of  5th  and  6th  cervical(T).  Vertical  part. 
Bodies  of  lower  two  cervical  and  upper  three  dorsal  and 
itranverse  processes  of  4th,  5th,  6th,  7th  cervical  vertebrae(FT) 
— bodies  of  and,  3rd  and  4th  cervical  vertebrae(T)  (Cervical 
nerves).  [Flexes  cervical  spine.] 

LATERAL   VERTEBRAL    REGION. 

Scalenus  anticus  :  anterior  tubercles  of  transverse  pro- 
•cesses  of  3rd,  4th,  5th,  6th  cervical  vertebrae(T) — scalene 
tubercle  on  inner  border  and  superior  surface  of  ist  rib(T) — 
(Branches  of  lower  cervical) .  [A  raises  ribs  as  in  forced  inspira- 
tion, B  flexes  spine  and  bends  neck  to  same  side.]  Phrenic  nerve 
lies  along  anterior  surface;  subclavian  artery  passes  behind  at  origin. 

Scalenus  medius  :  posterior  tubercles  of  transverse  pro- 
cesses of  lower  six  cervical  vertebrae(T) —rough  elevation  on 


32  THE  POCKET  ANATOMY 

superior  border  of  istrib,  behind  groove  for  subclavian  artery 
(F)  (Branches  of  lower  cervical).  [A  raises  ribs  as  in  forced 
inspiration,  B  flexes  spine  laterally.] 

Scalenus  posticus  :  posterior  tubercles  of  transverse  pro- 
cesses of  lower  two  or  three  cervical  vertebrae(x) — superior 
border  of  2nd  rib(x)  (Branches  of  lower  cervical).  [A  raises 
ribs,  B  flexes  cervical  spine  laterally.] 

POSTERIOR    VERTEBRAL    REGION. 

Rectus  capitis  posticus  major  :  spinous  process  of  axis(T) 
— outer  J  inferior  curved  line  of  occiput  and  bone  below(F) 
(ist  cervical,  posterior  primary  division).  [Extends  head  on 
spine.] 

Rectus  capitis  posticus  minor :  posterior  tubercle  of  neural 
arch  of  atlas(T) — inner  part  of  inferior  curved  line  of  occiput 
and  bone  between  this  and  foramen  magnum(F)  (ist  cervical, 
posterior  primary  division).  [Extends  head  on  spine.] 

Obliquus  inferior :  spinous  process  of  axis(p) — transverse 
process  of  atlas(T)  (ist  cervical,  posterior  primary  division). 
[Rotates  face  to  same  side.] 

Obliquus  superior :  superior  surface  of  transverse  process  of 
atlas(T) — occipital  bone,  between  the  two  curved  lines(p)  (ist 
cervical,  posterior  primary  division).  [Rotates  face  to  oppo- 
site side.] 


MUSCLES  AND   FASCLE  OF  UPPER  EXTREMITY. 

ANTERIOR    THORACIC    REGION. 

The  deep  fascia  of  the  pectoral  region  covers  the  large 
pectoral  muscle,  is  attached  above  to  the  clavicle,  internally 
to  the  sternum,  becoming  continuous  externally  with  fascia? 
of  shoulder,  axilla,  and  lateral  thoracic  region. 

The  costo-coracoid  membrane,  continuous  with  the  deep  fascia 
of  this  part,  is  attached  above  to  the  clavicle  so  as  to  enclose 
the  subclavius  muscle  ;  the  posterior  layer  is  continuous  with 
the  axillary  sheath  derived  from  the  deep  cervical  fascia. 
The  lower  edge  (costo-coracoid  ligament)  reaches  from  the 
ist  costal  cartilage  to  the  coracoid  process,  and  passes  down- 
wards over  pectoralis  minor.  It  is  pierced  by  cephalic  vein, 
acromio-thoracic  vessels,  and  external  anterior  thoracic  nerve. 

The  axillary  fascia  is  placed  across  the  axilla;  it  is  derived 
in  front  from  the  sheaths  of  the  pectoral  muscles,  and  joins, 
at  the  posterior  border  of  the  axilla,  the  sheaths  of  the  latis- 
simus  dorsi  and  teres  major. 


MUSCLES  33 

Pectoralis  major :  superiorly,  sternal  half  of  clavicle(p) ;  in- 
ternally, front  of  sternum,  cartilages  of  upper  six  ribs(F)  ;  in- 
fer iorly  aponeurosis  of  external  oblique  muscle  of  abdomen (F) 
— outer  ridge  of  bicipital  groove  of  humerus(T)  (External 
and  internal  anterior  thoracic).  [A  adducts  humerus,  flexes 
shoulder;  B  raises  ribs  in  forced  inspiration.]  Anterior 
boundary  of  axilla,  separated  front  the  deltoid  above  by  cephalic  vein 
and  branch  of  acromio  -  thoracic  artery. 

Pectoralis  minor  :  3rd,  4th,  and  5th  ribs  outside  cartilages, 
aponeurosis  over  intercostal  muscles(F) — anterior*  of  superior 
surface  and  inner  border  of  coracoid  process  of  scapula(x) 
(Internal  anterior  thoracic).  [Draws  scapula  forwards  and 
depresses  it.]  Forms  middle  £  of  anterior  axillary  boundary,  and 
conceals  2nd  part  of  axillary  artery. 

Subclavius  :  ist  rib  at  junction  of  bone  and  cartilage(x) — 
groove  on  under  surface  of  clavicle  between  the  two  tubercles(F) 
(Branch  from  5th  and  6th  cervical).  [Depresses  clavicle.] 
Encased  by  costo-coracoid  sheath. 

LATERAL   THORACIC    REGION. 

Serratus  magnus :  eight  or  nine  digitations  from  as  many 
ribs,  the  ist  digitation  being  attached  to  ist  and  2nd  ribs; 
aponeurosis  over  intercostal  muscles  ;  lower  four  slips  digitate 
with  external  oblique  muscle  of  abdomen(F) — vertebral  border 
of  ventral  surface  of  scapula;  viz.,  ist  digitation  from  ist 
and  2nd  ribs  to  upper  angle,  from  2nd  and  3rd  ribs  to  base ; 
the  rest  to  inferior  angle(p)  (Posterior  thoracic).  [Draws 
scapula  forwards,  and  by  rotating  inferior  angle  forwards 
and  upwards,  raises  arm.] 

ACROMIAL    REGION. 

The  deep  fascia  over  the  shoulder  conceals  the  back  part  of 
the  deltoid  and  the  infra-spinatus  muscle,  and  is  attached  to 
the  clavicle,  acromion,  and  spine  of  scapula. 

Deltoid :  outer  £  anterior  border  of  clavicle,  anterior  edge 
of  acromion,  all  lower  edge  of  spine  of  scapula(F) — rough 
deltoid  impression  on  outer  surface  of  humerus  just  above  the 
middle(T)  (Circumflex).  [Abducts  arm;  anterior  fibres  flex 
shoulder,  posterior  extend.] 

Parts  covered  by  deltoid :  head  and  neck  of  humerus ;  bursa 
between  head  of  humerus  and  muscle;  tendons  of  insertion 
of  subscapularis,  pectorales  major  and  minor,  teretes  naajor 
and  minor,  latissimus  dorsi,  supra- spinatus,  infra-spinatus. 
Origins  of  coraco-brachialis,  biceps  (two  heads),  triceps  (long 

3 


34  THE  POCKET  ANATOMY 

and  outer  heads):  capsular,  coraco  -  acromial,  humeral, 
clavicular,  costo-coracoid  (external  part)  ligaments ;  coracoid 
process :  acromio-thoracic,  supra-scapular,  branch  of  superior 
profunda,  and  circumflex  vessels  ;  circumflex  nerve. 

ANTERIOR   SCAPULAR   REGION. 

Subscapularis  :  all  subscapular  fossa,  except  at  neck,  angles, 
and  inner  border(p  T  A) — small  tuberosity  of  humerus(T)  and 
neck  of  humerus  for  one  inch  below(F)  (Short  subscapular 
and  branch  from  lower  subscapular).  [Flexes  and  inwardly 
rotates  shoulder-joint.]  Bursa  placed  between  the  tendon  and  root 
of  coracoid  process,  communicating  with  shoulder-joint. 

POSTERIOR    SCAPULAR   REGION. 

Supra-spinatus :  supra-spinous  fossa,  except  near  neck  of 
scapula ;  upper  surface  of  spine,  and  fascia  covering  muscle(F) 
—  upper  of  three  facets  upon  great  tuberosity  of  humerus(T) 
(Supra-scapular).  [Abducts  humerus.] 

Infra-spinatus  :  infra-spinous  fossa,  except  at  neck,  axillary 
border,  and  inferior  angle ;  from  inferior  surface  of  spine  of 
scapula,  and  fascia  covering  muscle(F)— middle  of  three  facets 
on  great  tuberosity  of  humerus(T)  (Suprascapular).  [Extends 
and  externally  rotates  shoulder-joint.] 

Teres  minor :  from  superior  §  of  axillary  border  of  dorsum 
of  scapula,  its  investing  fascia(p) — lowest  of  three  facets  upon 
great  tuberosity  of  humerus(T),  and  bone  below(p)  (Circum- 
flex ;  has  a  gangliform  swelling  on  it}.  [Adducts  and  externally 
rotates  humerus.]  Dorsal  branch  of  subscapular  artery  bends 
backwards  in  front  of  this  muscle  to  reach  infra-spinous  fossa. 

Teres  major  :  from  rough  surface  at  inferior  angle  of  dorsum 
of  scapula,  and  axillary  border  for  lower  ^,  septum  between  it 
and  teres  minor(p)  —inner  edge  of  bicipital  groove  of  humerus 
(T)  (Lower  subscapular).  [Adducts  and  internally  rotates 
humerus.]  A  bursa  is  sometimes  placed  between  tendon  and  humerus 
posteriorly ,  and  between  ten  don  and  latissimus  dor  si  insertion  an  teriorly . 

ANTERIOR    HUMERAL    REGION. 

The  deep  fascia  of  the  arm  is  continuous  with  that  of  the 
shoulder,  investing  the  muscles  of  this  region.  It  gives  off 
on  either  side  an  intermuscular  septum,  which  is  attached  to 
the^condyle  and  supra-condylar  ridge. 

Coraco  -brachialis:  apex  of  coracoid  process  of  scapula, 
tendon  of  coracoid  head  of  biceps(F) — rough  ridge  near  middle 


MUSCLES  35 

of  inner  surface  of  humerus  ;  some  of  the  upper  fibres  join  a 
fibrous  arch  which  is  attached  above  to  the  small  tuberosity(x) 
(Musculo-cutaneous).  [Flexes  and  adducts  shoulder-joint.] 
Brachial  vessels  to  inner  side. 

Biceps  :  Long  or  glenoid  head.  From  scapula  at  upper  border 
of  glenoid  cavity,  and  from  glenoid  ligament,  within  the 
shoulder-joint(T).  Short  or  coracoid  head.  Apex  of  coracoid 
process  of  scapula(x) — rough  and  hinder  part  of  tubercle  of 
radius(i)  and  fascia  of  forearm  (Musculo-cutaneous).  [Flexes 
shoulder,  flexes  elbow,  supinates  radius.]  A  bursa  is  placed 
on  the  smooth  and  fore  part  of  tubercle.  Inner  border,  the  guide 
to  brachial  vessels  below  middle  of  humerus.  A  broad  band,  the 
semilunar  fascia,  is  given  off  from  inner  side  of  tendon  opposite  the 
elbow-joint,  covering  brachial  artery  and  joining  deep  fascia  of  fore- 
arm. 

Brachialis  anticus  :  lower  half  of  outer  and  inner  surfaces 
of  shaft  of  humerus,  embracing  insertion  of  deltoid,  all  inner 
intermuscular  septum,  and  upper  part  of  outer  intermuscular 
septum (F) — rough  surface  in  front  of  coronoid  process  of 
ulna(T)  (Musculo-cutaneous,  Musculo-spiral).  [Flexes  elbow.] 
Brachial  artery,  median,  musculo  -  spiral  and  musculo  -  cutaneous 
nerves  lie  on  it. 

POSTERIOR    HUMERAL    REGION. 

Triceps  :  Long  or  middle  head.  Depression  on  axillary  border 
of  scapula,  close  beneath  glenoid  cavity(x).  External  head. 
From  root  of  great  tuberosity  to  musculo-spiral  groove  on 
posterior  surface  of  humerus(p).  Internal  head.  Posterior 
surface  of  shaft  of  humerus,  by  side  of  and  below  musculo- 
spiral  groove,  internal  and  external  intermuscular  septa(p) — 
posterior  surface  of  olecranon  process  of  ulna(x)  (Musculo- 
spiral).  [Extends  and  adducts  shoulder,  extends  elbow.] 
Bursa  is  placed  between  the  tip  of  process  and  tendon. 

Sub-anconeus  :  by  two  fasciculi  just  above  olecranon  fossa 
of  humerus(F) — synovial  sac  of  elbow-joint(F)  (Musculo-spiral). 
[Raises  synovial  membrane  out  of  olecranon  fossa  in  extension 
of  elbow.] 

OF  FOREARM — ANTERIOR,     (a)  Superficial  Layer. 

The  deep  fascia  of  the  forearm,  continuous  above  with  fascia 
of  arm,  is  attached  posteriorly  to  subcutaneous  edge  of  ulna, 
and  invests  the  muscles  in  this  region. 

Anterior  annular  ligament  (v.  p.  13)  is  continuous  by  its  upper 
border  with  the  deep  fascia  of  the  forearm. 

3-2 


36  THE  POCKET  ANATOMY 

Posterior  annular  ligament  (v.  p.  13)  is  the  thickened  lower 
part  of  the  posterior  part  of  the  deep  fascia. 

Pronotor  radii  teres :  Humeral  head.  Internal  supra-condylar 
ridge  of  humerus,  internal  condyle  of  humerus  by  common 
flexor  tendon.  Ulnar  head.  Inner  border  of  coronoid  process 
of  ulna,  fascia  and  septum (F) — rough  impression  about  middle 
of  outer  surface  of  radius(x)  (Median) £.7  [Flexes  elbow  and 
pronates  forearm.]  Median  nerve  enters  forearm  between  the  two 
heads  of  origin. 

Flexor  carpi  radialis  :  common  flexor  tendon  from  internal 
condyle  of  humerus(T),  aponeurosis  of  forearm,  intermuscular 
septa(p) — bases  of  palmar  aspect  of  2nd  and  3rd  metacarpal 
bones(x)  (Median)*,?  [Flexes  elbow  and  wrist,  abducts  hand.] 
External  edge  of  muscle,  guide  to  radial  artery.  Passes  through 
groove  in  trapezium,  and  has  special  sheath  externally  under  annular 
ligament. 

Palmaris  longus  :  common  flexor  tendon  from  internal  con- 
dyle of  humerus(x),  aponeurosis  of  forearm(F),  intermuscular 
septa(F) — Palmar  fascia,  and  a  slip  to  short  muscles  of  thumb 
(T)  (Median).?  [Flexes  wrist,  makes  tense  palmar  fascia.] 
Passes  over  annular  ligament. 

Flexor  carpi  ulnaris  :  Humeral  head.  Common  flexor  tendon, 
from  internal  condyle  of  humerus(T).  Ulnar  head.  Inner  side 
of  olecranon,  upper  f  of  posterior  border  of  ulna(A) — Pisiform 
bone  and  prolonged  to  base  of  5th  metacarpal  and  hook  of 
Cuneiform  bone(x)  (Ulnar)j8,J  [Flexes  elbow  and  wrist,  adducts 
hand.]  Radial  side  of  muscle,  guide  to  ulnar  artery.  Ulnar  nerve 
enters  forearm  between  two  heads  of  origin. 

Flexor  sublimis  digitorum,  vel  perforatus :  Humeral  head. 
Common  flexor  tendon  from  internal  condyle  of  humerus(x), 
internal  lateral  ligament(F),  intermus^ula^sejjtaCFV  Ulnar 
head.  Inner  border  of  coronoid  processoiulna.  '  Radial  head. 
Oblique  line  of  radius  below  tubercle,  and  part  of  anterior 
border(A) — sides  of  middle  phalanges  of  ringers,  tendon  being 
split  for  flexor  profundus  digitorum(x)  ( Median ).^|;/[Flexes 
elbow,  wrist,  carpal,  metacarpal,  and  ist  interphalangeal 
joints.]  Tendons  pass  under  annular  ligament,  in  pairs,  those  of 
middle  and  ring-finger  being  anterior  to  those  of  index  and  little 
fingers. 

(b)  Deep  Layer. 

Flexor  profundus  digitorum,  w/perforans :  upperf  of  anterior 
and  internal  surfaces  of  shaft  of  ulna,  upper  f  of  ulnar  half  of 
interosseous  membrane,  aponeurosis  from  posterior  border  of 
ulna(p) — palmar  surfaces  of  bases  of  last  phalanges(xj.  (Inner 


MUSCLES  37 

half,  Ulnar ;  Outer  half,  Anterior  interosseous  of  median.) 
[Flexes  wrist,  metacarpal,  phalangeal,  and  all  interphalangeal 
joints.]  Tendons  pass  beneath  annular  ligament. 

Flexor  longus  pollicis :  hollow  on  upper  §  of  anterior  sur- 
face of  shaft  of  radius,  outer  £  of  interosseous  membrane  for 
same  distance(p) ;  base  of  coronoid  process  of  ulna  by  a 
separate  slip(p) — base  of  last  phalanx  of  thumb(T)  (Anterior 
interosseous)^ )  [Flexes  wrist  and  all  joints  of  thumb.]  Tendon 
passes  beneath  the  annular  ligament. 

Pronator  quadratus :  anterior  surface  and  anterior  border 
of  shaft  of  ulna,  for  lower  fourth(p) — for  two  inches  into  lower 
end  of  anterior  surface  and  anterior  border  of  radius(p) 
(Anterior  interosseous).^ /[Pronates  radius.] 

POSTERIOR,     (a)  Superficial  layer. 

Supinator  longus :  upper  §  external  supra-condylar  ridge 
ofhumerus,  external  intermuscular  septum(p) — root  of  styloid 
process  of  radius(x)  (Musculo-spiral).  [Flexes  elbow  and 
pronates  or  supinates  radius  from  extreme  position  to  midway 
between  pronation  and  supination.] 

Extensor  carpi  radialis  longior :  lower  £  of  external  supra- 
condylar  ridge  of  humerus,  external  intermuscular  septum(p) 
— base  of  posterior  surface  of  2nd  raetacarpal(x)  (Musculo- 
spiral).  [Extends  elbow,  extends  and  abducts  hand.]  Passes 
in  groove,  posterior  to  styloid  process  of  radius. 

Extensor  carpi  radialis  brevior :  common  extensor  tendon 
from  external  condyle  of  humerus(x),  external  lateral  ligament, 
intermuscular  septum  (F) — base  of  posterior  surface  of  3rd 
metacarpal(x)  (Posterior  interosseous).  [Extends  elbow  and 
wrist,  abducts  hand.] 

Extensor  communis  digitorum :  common  extensor  tendon 
from  external  condyle  of  humerus(x) ;  intermuscular  septum(F) 
— dorsa  of  last  two  phalanges  of  fingers(x)  (Posterior  in- 
terosseous). [Extends  wrists  and  all  joints  of  carpus  and 
fingers.]  The  four  tendons  pass  through  a  separate  compartment  of 
the  posterior  annular  ligament  with  the  extensor  indicts.  The  tendons 
of  the  middle,  ring,  and  little  finger  are  connected  by  tendinous  slips. 

Extensor  minimi  digiti :  common  extensor  tendon  from 
external  condyle  of  humerus,  deep  fascia  and  intermuscular 
septum(x) — 2nd  and  3rd  phalanges  of  little  finger  joining 
common  expansion(x)  (Posterior  interrosseous).  [Extends 
wrist  and  all  joints  of  little  finger.]  Tendon  passes  through 
separate  sheath  of  posterior  annular  ligament,  below  which  it  splits 
into  two,  the  external  one  being  united  by  a  cross-piece  with  the 
tendon  of  common  extensor  going  to  little  finger. 


38  THE  POCKET  ANATOMY 

Extensor  carpi  ulnaris:  common  extensor  tendon  from 
external  condyle  of  humerus(T),  intermuscular  septum (F)  by 
aponeurosis  from  upper  §  of  posterior  border  of  ulna(A) — 
prominence  on  ulnar  side  of  base  of  5th  metacarpal  bone 
(T)  (Posterior  interosseous).  [Extends  wrist,  carpal  joints 
and  5th  metacarpo-phalangeal  joint,  adducts  hand.]  Has 
separate  sheath  in  posterior  annular  ligament. 

Anconeus  :  posterior  surface  of  external  condyle  of  humerus 
(T)  and  deep  fascia(F) — outer  side  of  olecranon,  impression  on 
upper  J  of  posterior  surface  of  ulna  limited  by  oblique  line(p) 
(Musculo-spiral).  [Extends  elbow.]  The  recurrent  interosseous 
vessels  lie  beneath  this  muscle. 

(b)  Deep  Layer. 

Supinator  brevis :  external  condyle,  external  lateraf  liga- 
ment of  elbow-joint,  orbicular  ligament  of  radius,  depression 
below  lesser  sigmoid  cavity,  external  edge  of  ulna  for  2  inches 
(F) — surrounds  upper  £  of  radius,  is  attached  to  all  the  neck, 
except  at  inner  side,  to  the  upper  £  of  posterior,  and  upper  £ 
of  external  surfaces(F)  (Posterior  interosseous).  [Extends 
elbow,  supinates  radius.] 

Extensor  ossis  metacarpi  ppllicis :  middle  £  of  posterior 
surface  of  shaft  of  radius,  special  impression  on  superior  and 
external  part  of  posterior  surface  of  ulna  for  same  length, 
intervening  interosseous  membrane(F) — dorsal  aspect  of  base 
of  ist  metacarpal  (Posterior  interosseous).  [Extends  ist 
carpo-metacarpal  joint  abducts  hand.]  The  radial  artery 
winds  backwards  beneath  tendon  near  carpus. 

Extensor  brevis  pollicis  :  posterior  surface  of  radius  and 
interosseous  membrane  below  preceding  muscle  for  about 
i£  inches(F)— dorsal  aspect  of  base  of  ist  phalanx  of  thumb 
(T)  (Posterior  interosseous).  [As  preceding ;  also  extends 
ist  metacarpo-phalangeal  joint  ]  Goes  through  groove  under 
posterior  annular  ligament  with  extensor  ossis  metacarpi 
pollicis. 

Extensor  longus  pollicis  :  posterior  surface  of  ulna,  on 
inner  side  and  below  extensor  ossis  metacarpi  pollicis  for 
4  inches,  interosseous  membrane(F) — dorsal  aspect  of  base 
of  last  phalanx  of  thumb(x)  (Posterior  interosseous).  [Ex- 
tends wrist  and  all  joints  of  thumb.]  Tendon  goes  through 
separate  sheath  of  posterior  annular  ligament,  and  below  is  separated 
from  other  extensors  of  thumb  by  a  triangular  interval,  which  con- 
tains the  radial  artery. 

Extensor  indicis  :  internal  part  of  posterior  surface  of  shaft 
of  ulna  for  about  3  inches  just  below  middle,  and  interosseous 


MUSCLES  39 

membrane(p) — joins  tendon  of  extensor  communis  digitorum 
to  2nd  and  3rd  phalanges  of  index-finger(x)  (Posterior  inter- 
osseous).  [Extends  wrist  and  all  joints  of  index.] 

THUMB,    THENAR    EMINENCE. 

Abductor  pollicis  :  ridge  of  trapezium,  sometimes  scaphoid, 
upner  part  of  annular  ligament(p) — outer  side  of  base  of  ist 
phalanx  of  thumb(x)  (Median).  [Abducts  thumb.] 

Opponens  pollicis  :  anterior  surface  and  ridge  of  trapezium, 
annular  ligament(p) — whole  length  of  radial  border  of  shaft  of 
ist  metacarpal(F)  ("Median).  [Opposes  thumb  to  palm.] 

Flexor  brevis  pollicis  :  Outer  head.  Lower  border  of  annular 
ligament — outer  margin  of  the  base  of  ist  phalanx  of  thumb 
(Median).  Inner  head.  Inner  side  of  base  of  tst  metacarpal 
bone— inner  side  of  base  of  ist  phalanx  of  thumb  (Ulnar). 
[Flexes  metacarpo-phalangeal  and  ist  interphalangeal  joint 
of  thumb.]  A  sesamoid  bone  developed  in  each  tendon  of  insertion. 
Deep  palmar  arch  of  radial,  issues  from  behind  inner  head. 

Adductor  obliquus  pollicis  :  sheath  of  flexor  carpi  radialis, 
anterior  carpal  ligaments,  os  magnum,  bases  of  2nd  and  3rd 
metacarpal  bones — inner  side  of  base  of  ist  phalanx  of  thumb 
(Ulnar).  [Adducts  and  flexes  thumb.] 

Adductor  transversus  pollicis  :  ridge  on  lower  §  of  anterior 
surface  of  shaft  of  3rd  metacarpal(p) — ulnar  side  of  base  of  ist 
phalanx  of  thumb(x)  (Ulnar).  [Adducts  and  flexes  thumb.] 

LITTLE   FINGER,    HYPOTHENAR   EMINENCE. 

Palmaris  brevis  :  annular  ligament,  palmar  fascia(p) — skin 
on  ulnar  side  of  palm(p)  (Ulnar).  [Corrugates  skin  on  ulnar 
side  of  palm.] 

Opponens  minimi  digiti :  process  of  unciform  bone,  lower 
part  of  annular  ligament(p)— ulnar  edge  of  5th  metacarpal(F) 
( Ulnar).  [Opposes  little  finger  to  palm.] 

Flexor  brevis  minimi  digiti :  tip  of  process  of  unciform, 
annular  ligament(p) — ulnar  side  of  base  of  ist  phalanx  of  little 
finger(T)  (Ulnar).  [Flexes  little  finger.] 

Abductor  minimi  digiti :  pisiform  bone,  tendon  of  flexor 
carpi  ulnaris(p) — ulnar  side  of  base  of  ist  phalanx  of  little 
finger(T)  (Ulnar).  [Abducts  little  finger.] 

DEEP   PALMAR    REGION. 

Lumbricales  (4) :  radial  side  of  deep  flexor  tendons  (2  inner 
from  ulnar  margins  of  and  and  3rd  tendons  also)  (K) — radial 


40  THE  POCKET  ANATOMY 

side  of  tendinous  expansion  on  dorsa  of  ist  phalanges  of 
fingers(r)  (2  outer  median,  2  inner  ulnar).  [Flex  metacarpo- 
phalangeal  and  extend  interphalangeal  joints.] 

Interossei  dorsales  (4) :  ist  muscle  (abductor  indicts).  Outer 
head.  From  upper  ^  of  ulnar  border  of  ist  metacarpal(F). 
Inner  head.  Radial  border  of  2nd  metacarpal(F).  The  others 
from  posterior  part  of  lateral  surfaces  of  both  metacarpals, 
between  which  they  lie — ist  and  2nd  muscles  to  radial  side  of 
ist  phalanx  of  index  and  middle  fingers  respectively,  3rd  and 
4th  in  similar  manner  to  ulnar  side  of  middle  and  ring  fingers 
(T).  Each  is  inserted  partly  into  base  of  ist  phalanx,  and 
partly  into  expansion  of  common  extensor  on  ist  phalanx(x) 
(Ulnar).  [Abduct  fingers  from  middle  line  of  hand — i.e.,  3rd 
(middle)  finger  ;  also  same  action  as  lumbricales.] 

Interossei  palmares  (3) :  ist  from  ulnar  side  of  2nd  meta- 
carpal,  2nd  and  3rd  from  radial  sides  of  4th  and  5th  meta- 
carpals respectively  (F) — ist  phalanx  of  finger  from  which  they 
arise  and  on  the  same  side  as  the  origin,  and  into  extensor 
tendon  expansion(x)  (Ulnar).  [Adduct  fingers  towards  middle 
line,  and  same  action  as  lumbricales.] 


MUSCLES  AND  FASCIA  OF  BODY. 

BACK,    IST   LAYER. 

Trapezius  :  spinous  processes  of  all  dorsal  and  7th  cervical 
vertebrae,  with  supra-spinous  ligaments,  ligamentum  nuchas, 
inner  Jrd  of  superior  curved  line  of  occiput(T) — outer  £rd  of 
posterior  border  of  clavicle,  superior  edge  of  acromion,  superior 
lip  of  posterior  border  of  spine  of  scapula(F),  and  rough  im- 
pression on  spine  about  i  inch  from  root(T)  (Spinal  accessory, 
3rd  and  4th  cervical  by  cervical  plexus.)  [A — Upper  fibres 
draw  scapula  and  clavicle  upwards,  lower  fibres  downwards,  all 
backwards  ;  B  pulls  head  backwards,  and  also  flexes  to  same 
side.]  Anterior  margin  forms  posterior  boundary  of  posterior 
triangle  of  neck. 

Latissimus  dorsi:  spinous  processes  of  lower  6  dorsal, 
supra-spinous  ligaments(A) ;  from  the  posterior  layer  of  the 
lumbar  aponeurosis,  by  which  it  is  attached  to  all  the  lumbar 
and  sacral  spines,  and  posterior  £  of  outer  edge  of  iliac  crest, 
beyond  this  for  i  inch(p),  lower  3  or  4  ribs(F),  and  occasionally 
a  slip  from  angle  of  scapula — bottom  of  bicipital  groove  of 
humerus(x)  (Long  subscapular).  [Draws  arm  down  and  back- 
wards, rotating  inwards.]  In  the  back  the  latissimus  is  posterior  to 


MUSCLES  4» 

the  teres  major,  but  twisting  upon  itself  it  is  inserted  anteriorly  to 
teres,  and  lowest  fibres  are  inserted  highest. 

BACK,    2ND   LAYER. 

Levator  anguli  scapulae :  posterior  tubercles  of  transverse 
processes  of  upper  three  or  four  cervical  vertebrae  (T) — verte- 
bral border  of  scapula  between  spine  and  superior  angle  (F) 
(5th  cervical  [nerve  to  rhomboidei]  and  deep  branches  from 
3rd  and  4th  cervical).  [Elevates  scapula.]  Forms  part  oj 
floor  of  posterior  triangle  of  neck. 

Rhomboideus  minor :  ligamentum  nuchae,  spinous  processes 
of  yth  cervical  and  ist  dorsal  vertebrae(T) — vertebral  border 
of  scapula,  opposite  root  of  spine(p)  (sth  cervical).  [Elevates 
and  draws  back  scapula.] 

Rhomboideus  major :  spines  and  supra-spinous  ligaments 
of  upper  4  or  5  dorsal  vertebrae,  below  preceding(x)— vertebral 
border  of  scapula  between  spine  and  inferior  angle  (F)  (5th 
cervical).  [Elevates  and  draws  back  scapula.]  Sometimes 
the  fibres  end  in  a  tendinous  arch  near  the  bone. 

BACK,    3RD   LAYER. 

Serratus  posticus  superior:  ligamentum  nuchae,  spinous 
processes  of  yth  cervical  and  two  or  three  superior  dorsal 
vertebrae,  supra-spinous  ligament(A)— upper  borders  and  outer 
surfaces  of  2nd,  3rd,  4th,  and  5th  ribs  external  to  angle(p) 
(External  posterior  branches  of  dorsal).  [Elevates  upper 
ribs.] 

Serratus  posticus  inferior:  spinous  processes  of  nth  and 
1 2th  dorsal,  and  ist  and  2nd  lumbar  vertebrae,  and  from 
tendon  of  origin  of  latissimus  dorsi  and  the  fascia  lum- 
borum(A)— inferior  borders  of  lower  four  ribs  external  to 
angle(p)  (External  posterior  branches  of  dorsal).  [Draws 
lower  ribs  downwards  and  backwards,  fixing  them  for  dia- 
phragm to  act  from.] 

The  vertebral  aponeurosis.  A  thin  membrane,  attached  to 
the  spines  of  the  dorsal  vertebrae,  and  passing  outwards  to 
the  angles  of  the  ribs.  Below  it  is  joined  to  the  upper  edge 
of  the  inferior  serratus  and  the  tendon  of  latissimus,  whilst 
above  it  passes  beneath  the  superior  serratus  and  splenius  to 
become  continuous  with  the  deep  fascia  of  the  neck.  It  binds 
down  the  erector  spinae  in  the  groove  between  the  vertebral 
spines  and  the  angles  of  the  ribs. 

Splenius  :  lower  £  of  ligamentum  nuchae,  spinous  processes 
of  yth  cervical  and  upper  6  dorsal  vertebrae,  supra-spinous 


42  THE  POCKET  ANATOMY 

ligaments(A) — Capitis,  apex  and  hinder  border  of  mastoid 
process,  outer  £  superior  curved  line  of  occiput(T) ;  Colli, 
posterior  tubercles  of  transverse  processes  of  ist,  2nd,  and 
3rd  cervical  vertebrae (T)  (External  posterior  branches  of  cer- 
vical). [Extends  spine  and  head  ;  laterally  flexes  head  and 
rotates  face  to  the  same  side.] 


BACK,    4TH   LAYER. 

Erector  spinse :  Outer  mass.  Ilio-costalis,  musculus  ac- 
cessorius,  cervicalis  ascendens.  Inner  mass.  Longissimus 
dorsi,  transversalis  colli,  trachelo-mastoid.  [In  all  its  parts 
extends  spine.] 

Erector  spinse  :  posterior  ith  inner  lip  of  iliac  crest,  from 
the  sacral  transverse  processes,  and  lower  part  of  posterior 
surface  of  sacrum,  from  the  sacral,  lumbar  and  lower  3  dorsal 
spines,  with  supra-spinous  ligaments(x).  Divides  opposite 
last  rib  into  sacro-lumbalis  and  longissimus  dorsi  (External 
posterior  branches  of  sacral  and  lumbar). 

Ilio-costalis  :  erector  spinas(F) — angles  of  lower  6  or  7  ribs 
(T)  (External  posterior  branches  of  lumbar  and  dorsal). 

Musculus  accessorius  :  angles  of  lower  6  ribs(x) — angles  of 
upper  6  ribs,  and  transverse  process  of  7th  cervical(x) 
(External  posterior  branches  of  dorsal). 

Cervicalis  ascendens  :  angles  of  3rd,  4th,  5th,  and  6th  ribs 
(T) — Posterior  transverse  tubercles  of  6th,  5th,  and  4th 
cervical  vertebrae(x)  (External  posterior  branches  of 
cervical). 

Longissimus  dorsi.  (See  erector  spines,  of  which  it  forms  nearly 
the  whole  of  the  inner  mass.) — Internally.  Accessory  processes 
of  lumbar  and  transverse  processes  of  dorsal  vertebrae(XF). 
Externally.  Lumbar  transverse  processes(p),  middle  layer  of 
fascia  lumborum  :  to  all  the  ribs  except  first  two  or  three 
by  fleshy  processes  between  tubercle  and  angle(p)  (External 
posterior  branches  of  lumbar  and  dorsal). 

Transversalis  colli  :  transverse  processes  of  upper  5  dorsal 
vertebrae(x) — Posterior  tubercles  of  transverse  processes  of 
6th,  5th,  4th,  3rd,  and  and  cervical  vertebrae (x)  (External 
posterior  branches  of  cervical). 

Trachelo-mastoideus:  transverse  processes  of  upper  4 
dorsal  vertebrae(x),  articular  processes  of  7th,  6th,  5th,  and 
4th  cervical  vertebrae  (x) — posterior  edge  of  mastoid  process 
(F)  (External  posterior  branches  of  cervical). 

Spinalis  dorsi :  spinous  processes  of  nth  and  i2th  dorsal 
and  ist  and  2nd  lumbar  vertebras (FX) — Spinous  processes  of 


MUSCLES  43 

upper  4  or  8  dorsal  vertebrae(T)  (External  posterior  branches 
of  dorsal  and  lumbar). 

Complexus  :  transverse  processes  of  upper  6  dorsal  and  yth 
cervical,  articular  processes  of  inferior  3  or  4  cervical,  and 
spinous  process  of  yth  cervical  vertebrae(T)  —  Impression 
between  superior  and  inferior  curved  lines  of  occiput(F) 
(Suboccipital,  internal  posterior  branches  of  cervical).  [Ex- 
tends head,  and  rotates  face  to  the  opposite  side.]  The  inner 
part  of  this  muscle  is  sometimes  described  as  a  separate  muscle,  called 
biv enter  cervicis. 

BACK,    5TH    LAYER. 

Semi-spinalis  dorsi  :  transverse  processes  of  loth,  gth,  8th, 
7th,  and  6th  dorsal  vertebrae(x) — Spinous  processes  of  upper 
four  dorsal  and  last  two  cervical  vertebrae(T)  (Internal  pos- 
terior branches  of  dorsal).  [Extends  spine.] 

Semi-spinalis  colli  :  transverse  processes  of  upper  6  dorsal 
(FT) — spinous  processes  of  and,  3rd,  4th,  and  5th  cervical 
vertebrae(T)  (Internal  posterior  branches  of  cervical).  [Ex- 
tends spine.] 

Multifidus  spinse :  back  of  sacrum  as  low  as  4th  sacral 
foramen;  inner  surface  of  posterior  superior  iliac  spine, 
posterior  sacro-iliac  ligament,  mammillary  processes  of  lum- 
bar, transverse  processes  of  dorsal,  articular  processes  of 
lower  5  cervical  vertebrae(Fx) — spines  and  neural  arches  of 
vertebrae  from  3rd  sacral  to  and  cervical(p)  (Internal  posterior 
branches  of  sacral,  lumbar,  dorsal  and  cervical).  [Extends 
spine.]  Fills  groove  on  either  side  of  spinous  processes  of  vertebra. 

Rotatores  spinse,  vel  dorsi  (eleven  in  number) :  tip  and 
upper  edge  of  transverse  process  of  a  dorsal  vertebra(p) — 
lower  border  of  lamina  of  vertebra  next  above  (A)  (Internal 
posterior  branches  of  dorsal).  [Rotate  spine.] 

Inter-spinales :  placed  in  pairs,  one  on  each  side  of  inter- 
spinous  ligament  between  spinous  processes  (Internal  posterior 
branches  of  cervical,  dorsal,  and  lumbar).  [Extend  spine.] 
These  muscles  are  wanting  between  ist  and  2nd  cervical,  and  all  the 
dorsal  except  first  and  last  two  pairs. 

Inter  -  transversales :  lie  between  transverse  processes. 
Cervical  (seven  pairs,  two  sets).  One  set  attached  to  anterior, 
the  other  to  the  posterior  tubercles.  Dorsal.  Single  sets, 
from  three  to  six  in  number,  attached  to  the  processes  of 
the  lower  vertebrae.  Lumbar.  Four  in  number,  the  lower 
ones  filling  up  the  spaces  between  processes  entirely.  A 
second  set  here  pass  between  adjacent  accessory  processes. 
(Internal  posterior  branches  of  cervical,  dorsal,  and  lumbar). 
[Laterally  flex  spine.] 


44  THE  POCKET  ANATOMY 


ABDOMINAL    REGION. 

Obliquus  abdominis  externus:  eight  digitations  from  in- 
ferior  borders  and  outer  surface  of  eight  lower  ribs,  upper 
five  digitating  with  serratus  magnus,  lower  three  with  latis- 
simus  dorsi(p) — Anterior  half  of  external  lip  of  iliac  crest,  and 
aponeurosis  in  front  of  belly,  which  is  attached  to  pubic 
spine  and  symphysis  below(A),  blends  above  with  the  fascia 
over  the  pectoralis  major,  and  joins  in  the  middle  line  with 
the  opposite  aponeurosis,  forming  the  linea  alba ;  the  rest  of 
the  fibres  forming  Poupart's  and  Gimbernat's  ligaments  (A) 
(Lower  intercostals.Ilio-hypogastric,  and  Ilio-inguinal).  [Sup 
ports  and  compresses  viscera,  draws  down  lower  ribs,  and 
laterally  flexes  thorax.] 

The  external  abdominal  ring  is  an  opening  formed  by  a  diver- 
gence of  some  of  the  lower  fibres  of  the  aponeurosis  of  the 
external  oblique  muscle ;  it  is  situated  just  above  the  crest  of 
the  pubes,  and  transmits  spermatic  cord  in  male  and  round 
ligament  in  female.  Boundaries — Below.  Pubic  crest.  Above. 
Arched  fibres.  Laterally.  External  and  internal  pillars  ;  the 
external  pillar  is  attached  below  to  pubic  spine,  the  internal 
pillar  to  pubic  symphysis.  The  intercolumnar  fascia  passes 
between  the  pillars,  and  is  prolonged  downwards  over  the  cord. 

Poupart's  Ligament.  The  part  of  the  aponeurosis  of  the  ex- 
ternal oblique  extending  between  anterior  superior  iliac  spine 
and  pubic  spine.  The  inner  attachment  is  prolonged  along 
the  pectineal  line,  forming  Gimbernat's  ligament,  of  which 
some  fibres  are  again  reflected  upwards  and  inwards  to  linea 
alba,  forming  triangular  fascia. 

Obliquus  interims :  outer  £  of  Poupart's  ligament,  anterior 
§  middle  lip  of  iliac  crest,  fascia  lumborum  between  iliac 
crest  and  I2th  rib(p) — inferior  edges  of  cartilages  of  lower  three 
ribs  on  posterior  surface,  aponeurosis  blending  with  its  fellow 
at  linea  alba;  some  of  the  lower  fibres  of  the  aponeurosis 
arch  over  spermatic  cord,  join  tendon  of  transversalis  just 
above  pectineal  line,  forming  the  conjoined  tendon,  which  is 
attached  to  pectineal  line,  and  crest  of  pubes(T)  (Lower  inter- 
costals,  Ilio-hypogastric).  [As  externus.]  Aponeurosis  forms 
sheath  to  encase  the  rectus  except  at  lower  fourth  posteriorly. 

Cremaster  (peculiar  to  male) :  middle  of  Poupart's  ligament 
and  internal  oblique(p) — crest  of  os  pubis(x)  (Genito-crural). 
[Supports  and  raises  testis.]  Fibres  embedded  in  fascia  (cremas- 
teric)  derived  from  internal  oblique,  covering  cord  and  testis. 

Transversalis  :  outer  £  Poupart's  ligament,  anterior  f  inner 
lip  iliac  crest,  inner  surfaces  of  cartilages  of  lower  six  ribs(p) 


MUSCLES  45 

fascia  lumborum(T) — lower  fibres  end  in  the  conjoined  tendon, 
inserted  into  pubes  and  pectineal  line(x) ;  rest  of  fibres  ter- 
minate in  an  aponeurosis  attached  to  linea  alba(A)  (Lower 
intercostals,  Ilio-hypogastric,  Ilio-inguinal) .  [Supports  and 
compresses  viscera.]  As  low  as  midway  between  pubes  and 
umbilicus,  the  aponeurosis  is  posterior  to  the  rectus,  but  below  this 
level  it  is  anterior. 

The  Posterior  aponeurosis  of  the  Transversalis  or  fascia  lumborum 
is  attached  to  the  lower  border  of  the  last  rib  above,  and  to 
the  ilio-lumbar  ligament  and  posterior  part  of  the  iliac  crest 
below.  Tracing  it  towards  the  spine,  it  splits  to  enclose  the 
quadratus,  and  becomes  attached  to  the  lumbar  transverse 
processes.  From  the  posterior  of  these  layers  a  process  is 
given  off  to  the  lumbar  spines,  enclosing  the  erector  spinse. 

Rectus  abdominis  :  pubic  crest  and  symphysis(x) — ensiform 
appendix,  cartilages  of  5th,  6th,  and  yth  ribs,  bone  and 
cartilage  of  5th  rib(FT)  (Lower  intercostals  Ilio-hypogastric). 
[Supports  viscera,  flexes  spine,  A  drawing  down  thorax, 
B  drawing  up  pelvis,  as  in  climbing.]  Traversed  by  three  or 
four  tendinous  intersections,  linea  transverse.  Sheath  of  rectus. 
Aponeurosis  of  internal  oblique  splits  at  outer  edge  of  muscle, 
one  piece  passing  anteriorly,  the  other  posteriorly.  The 
posterior  part  is  joined  by  aponeurosis  of  transversalis,  and 
is  deficient  at  lower  fourth ;  the  lower  free  border  forms  the 
Fold  of  Douglas.  The  anterior  part  blends  with  aponeurosis 
of  the  external  oblique. 

Pyramidalis  :  front  of  pubes  and  anterior  pubic  ligament(x) 
— linea  alba(x)  midway  between  umbilicus  and  pubes  (i2th 
intercostal).  [Makes  linea  alba  tense.]  Enclosed  in  sheath  of 
rectus,  and  frequently  absent. 

Quadratus  lumborum  :  Anterior  part.  Upper  edge  of  trans- 
verse processes  of  3rd,  4th  and  5th  lumbar  vertebrae — inner  £ 
lower  border  1 2th  rib.  Posterior  part.  Ilio-lumbar  ligament, 
and  inner  lip  of  iliac  crest  for  2  inches  external  to  it  (A) — apices 
of  transverse  processes  of  upper  four  lumbar (T),  inner  £  in- 
ferior border  of  i2th  rib(p)  (Anterior  branches  of  lumbar). 
[Flexes  spine  laterally,  draws  down  last  rib  and  with  its  fellow 
extends  spine.] 

THORACIC    REGION. 

Intercostales  extern!  (n):  outer  lip  of  groove  on  inferior 
border  of  rib,  from  the  tubercle  to  costal  cartilage(K) — outer 
-edge  of  superior  border  of  rib  belo  W(F)  (Intercostals) .  [Elevate 
Tibs  and  aid  inspiration.]  Fibres  run  downwards  ana  forwards. 


46  THE  POCKET  ANATOMY 

The  corresponding  spaces  between  the  rib  cartilages  are  occupied  by  th* 
anterior  intercostal  aponeurosis. 

Intercostales  intern!  (n) :  inner  lip  of  groove  on  inferior 
border  of  rib,  extending  from  angle  to  sternum(F)  — inner  edge 
of  superior  border  of  rib  below  (Intercostals).  [Probably  ele- 
vate ribs  and  aid  inspiration.]  Fibres  run  downwards  and  back- 
wards, but  not  so  obliquely  as  the  external  muscles.  The  inner  surface 
of  each  intercostal  space  between  the  tubercle  and  angle  is  occupied  by 
the  posterior  intercostal  aponeurosis.  The  intercostal  vessels  and 
nerve  lie  between  the  external  and  internal  muscles. 

Subcostales  (10)  :  inner  surface  of  a  rib,  near  angle(p) — 
inner  surface  of  ist,  2nd,  or  3rd  ribs  below(FT)  (Intercostals). 
[Elevate  ribs.] 

Triangularis  aterni :  side  of  ensiform  appendix  and  sternum, 
as  high  as  3rd  intercostal  space,  posterior  surfaces  of  cartilages 
of  7th,  6th,  and  5th  ribs(F)— posterior  surfaces  of  2nd,  3rd,  4th, 
5th  and  6th  ribs  at  junction  of  bone  and  cartilage(TF)  (Anterior 
branches  of  intercostals).  [Draws  down  ribs.] 

Levatores  costamm  (12)  :  apex  and  lower  border  of  trans- 
verse processes  of  yth  cervical  and  upper  n  dorsal  vertebrse 
(T) — superior  border  of  rib  below,  extending  from  tubercle  to 
angle(F)  (Intercostals).  [Raise  ribs.] 

DIAPHRAGMATIC    REGION. 

Diaphragma  :  posterior  surface  of  ensiform  appendix,  in- 
ternal surfaces  of  lower  six  costal  cartilages(F),  ligamenta 
arcuata  (externa  et  interna)  (A).  Right  crus,  from  bodies  and 
intervertebral  substances  of  ist,  2nd,  3rd  lumbar  vertebrae(T). 
Left  crus,  from  bodies  and  intervertebral  substances  of  ist 
and  2nd  lumbar  vertebrae(T) — central  tendon  (Phrenics).  [En- 
larges vertical  diameter  of  thorax,  so  aids  inspiration.]  The 
ligamentum  arcuatum  internum  arches  over  psoas,  attached  to 
body  of  ist  lumbar  vertebra  internally  and  to  transverse  pro- 
cess of  ist  lumbar  vertebra  externally.  The  ligamentum  arcuatum 
externum  reaches  from  transverse  process  of  ist  lumbar  ver- 
tebra to  lower  border  and  apex  of  last  rib,  arching  over 
quadratus. 

Openings.  AORTIC(F)  :  between  the  crura  and  spine,  trans- 
mits aorta,  thoracic  duct,  and  vena  azygos  major.  CESOPHA- 
GEAL(F)  :  above  and  little  to  left  of  aortic,  transmits  0330- 
phagus  and  pneumogastric  nerves.  CAVAL(T)  :  in  the  right 
leaflet  of  tendon,  transmits  vena  cava  inferior,  which  is  in- 
separably united  to  it.  In  each  crus  there  is  a  fissure  for  the 
three  splanchnic  nerves,  the  left  one  transmitting  in  addition 


MUSCLES  47 

the  vena  azygos  minor.     The  cord  of  the  sympathetic  per- 
forates the  outer  part  of  the  crus. 

PERINEAL    REGION. 

Superficial  Fascia.  In  the  anterior  half  of  the  perineum  this 
consists  of  two  layers,  the  superficial  fatty  and  the  deep  layer 
fibrous  and  well  marked  (fascia  of  Colles) :  the  latter  is  attached 
to  rami  of  pubes  and  ischium,  and  from  ischial  tuberosity  to 
central  point  of  perineum  ;  here  it  joins  the  triangular  liga- 
ment, by  turning  round  the  transversus  perinei.  It  is  con- 
tinuous in  front  with  the  dartos.  and  from  its  deep  surface  there 
is  a  septum  passing  forwards  to  scrotum  in  the  middle  line. 

Triangular  Ligament  of  the  Urethra,  or  Deep  Perineal  Fascia, 
consists  of  two  layers.  The  anterior  layer  is  attached  to  the 
symphysis  and  to  rami  of  pubes  and  ischium  on  each  side, 
and  joins  the  superficial  fascia  where  this  curves  over  the 
transversus  perinei.  About  an  inch  below  the  symphysis  it  is 
perforated  by  the  urethra,  and  above  this  by  the  dorsal  vein 
of  the  penis,  and  on  either  side  of  this  opening  the  dorsal  artery 
and  nerve  of  penis  are  transmitted.  The  posterior  layer 
consists  of  two  lateral  portions  separated  in  the  median  line 
by  the  urethra,  and  continuous  with  the  recto-vesical  fascia 
in  the  middle  line,  which  here  invests  the  prostate  ;  exter- 
nally it  joins  the  obturator  fascia  on  the  pubic  and  ischial 
rami,  and  is  really  the  subpubic  part  of  the  parietal  pelvic 
fascia. 

Parts  between  the  two  layers  of  the  triangular  ligament.  Sub- 
pubic  ligament,  dorsal  vein  of  penis,  membranous  part  of 
urethra,  compressor  urethrae.  Cowper's  glands  and  ducts, 
internal  pudic  arteries  giving  off  branches  to  bulb,  to  glands 
of  Cowper,  and  the  artery  to  corpus  cavernosum,  and  the 
dorsal  nerves  of  penis. 

THE  PELVIC  FASCIA.  Lines  muscles  of  pelvis  and  forms 
f  oor  of  outlet  of  pelvis.  Consists  of  parietal  and  visceral 
layers. 

Parietal  Layer,  (a)  The  Obturator  Fascia.  Covers  inner 
surface  of  obturator  internus.  It  is  attached  above  to  ilio- 
pectineal  line,  to  oblique  line  on  posterior  surface  of  body  of 
pubes  from  symphysis  to  upper  part  of  thyroid  foramen. 
Posteriorly  it  is  attached  to  the  anterior  edge  of  the  sacro- 
sciatic  notch  and  large  sacro-sciatic  ligament,  whilst  below  it 
is  attached  to  the  rami  of  pubis  and  ischium,  and  in  front  in 
the  subpubic  angle  is  continuous  with  the  posterior  layer  of 
the  triangular  ligament.  At  th^  top  of  the  thyroid  foramen 


48  THE  POCKET  ANATOMY 

the  fascia  joins  the  obturator  membrane,  its  bony  attachment 
being  here  interrupted,  and  forms  thus  the  floor  of  the  short 
canal  which  transmits  the  obturator  vessels  and  nerve.  The 
upper  part  of  the  fascia  is  in  the  pelvic  cavity,  and  is  lined 
by  peritoneum,  whilst  the  lower  part  forms  the  outer  boundary 
of  the  ischio-rectal  fossa,  and  encases  the  internal  pudic 
vessels  and  pudic  nerve  as  they  pass  forwards. 

(b)  The  Fascia  of  the  Pyriformis  is  the  continuation  of  the 
obturator  fascia  to  the  sacrum,  and  lies  anterior  to  the  pyri- 
formis  and  sacral  plexus. 

Visceral  Layer.  The  Recto-vesical  Fascia  is  attached  in  front 
to  the  posterior  surface  of  the  pubis,  close  to  the  obturator 
fascia,  the  origin  of  the  levator  ani  intervening.  Laterally 
it  is  attached  to  the  obturator  fascia  along  a  line  from  the 
upper  part  ol  the  thyroid  foramen  to  the  ischial  spine,  whilst 
behind  it  joins  the  lower  part  of  the  pyriformis  fascia.  From 
these  attachments  it  passes  downwards  and  inwards  over  the 
upper  surface  of  the  levator  ani  to  the  prostate,  bladder  and 
rectum,  joining  the  fascia  of  the  opposite  side  in  front  of  the 
bladder,  and  between  the  bladder  and  the  rectum,  thus  form- 
ing the  floor  of  the  pelvis.  Along  the  attachment  of  the  recto- 
vesical  to  the  obturator  fascia  is  a  thickened  band,  the  white 
line  of  the  pelvic  fascia. 

Processes  from  the  recto-vesical  fascia  : — 

Pubo -pro  static  ligaments  or  anterior  true  ligaments  of  the  bladder. 
Narrow  fasciculi,  one  on  each  side,  passing  from  the  back 
of  the  pubes  to  the  front  of  the  prostate  and  neck  of  the 
bladder. 

Lateral  true  ligaments  of  the  bladder.  This  is  the  anterior 
ligament  prolonged  laterally,  and  passes  to  the  side  of  the 
prostate,  and  to  the  side  of  the  bladder  above  the  vesiculae 
seminalis,  enclosing  the  prostatic  plexus,  whilst  posteriorly  it 
is  attached  to  the  bladder  between  the  vesiculae,  and  is  pro- 
longed downwards  over  and  enclosing  them,  being  joined  to 
a  like  process  from  the  opposite  side. 

Ligament  of  the  rectum.  A  piece  of  fascia  descends  from  the 
ischium  and  is  attached  to  the  rectum  on  each  side. 

In  the  female  the  vagina  receives  a  prolongation  of  the 
recto-vesical  fascia  corresponding  to  the  prostatic  sheath. 

Sphincter  ani  externus  :  tip  and  back  of  coccyx  and  sub- 
cutaneous fatty  layer  on  either  side(TF) — central  perineal 
tendon(F)  (4th  sacral  and  inferior  haemorrhoidal  of  pudic). 
[Closes  anus.] 

Sphincter  ani  internus  :  the  involuntary  muscular  fibres  of 
the  large  intestine  thickened  about  \  inch  deep.  [Closes  anus.] 


MUSCLES  49 

Bulbo-cavernosus,  vel  accelerator,  vel  ejaculator  uriuae  : 
central  perineal  tendon  and  raphe(v) — Posterior  fibres.  Under 
surface  of  triangular  ligament(F).  Middle  fibres  surround  bulb 
and  corpus  spongiosum.  Anterior  fibres.  Side  of  corpus 
cavernosum,  and  united  with  one  on  opposite  side  it  encases 
dorsal  vessels(A)  (Deep  perineal  of  pudic).  [Compresses 
bulbous  urethra,  discharging  its  contents.] 

Erector  penis,  vel  ischio-cavernosus :  internal  surface  of 
tuber  ischii(TF) — internal  and  external  surfaces  of  crus  penis 
(T)  (Deep  perineal  of  pudic).  [Compresses  crus  and  produces 
erection.] 

Transversus  perinaei :  internal  surface  of  tuber  ischii(T) — 
central  perineal  tendon(p)  (Deep  perineal  of  pudic).  [Draws 
back  and  fixes  central  point  of  perineum.] 

Levator  ani :  posterior  surface  of  pubis  near  symphysis, 
spine  of  ischium,  and  between  these  two  points  from  recto- 
vesical  fascia,  along  attachment  of  obturator  fascia(T) — central 
perineal  tendon,  sides  of  rectum  and  coccyx(p)  (Perineal  of 
pudic  and  Anterior  division  of  4th  sacral).  [Supports  pelvic 
viscera,  compresses  and  raises  lower  part  of  rectum  in  defaeca- 
tion.]  Forms  floor  of  pelvic  cavity. 

Compressor  vel  constrictor  urethras :  internal  surface  of  pubic 
arch,  posterior  surface  of  triangular  ligament(A) — muscle  of 
opposite  side(x)  (Deep  perineal  of  pudic).  [Constricts  urethra 
and  expels  contents.]  Surrounds  membranous  portion  of  urethra. 

Coccygeus :  upper  part  of  ischial  spine,  small  sacro-sciatic 
ligament(TF) — side  and  anterior  surface  of  coccyx  and  last 
piece  of  sacrum(p)  (Anterior  division  of  4th  sacral).  [Supports 
pelvic  floor.] 

Note. — In  the  female  the  perineal  muscles  are  essentially 
the  same :  for  erector  penis,  read  erector  clitoridis,  inserted 
into  side  of  clitoris.  The  sphincter  vagina,  corresponding  to 
ejaculator  urinae,  is  attached  to  the  central  tendon  of  the 
perineum,  and  passing  forwards  on  each  side  of  the  vagina — 
corpora  cavernosa  and  body  of  clitoris. 


MUSCLES  AND  FASCIAE  OF  LOWER  EXTREMITY. 

The  FASCIA  LATA  of  the  thigh  envelops  the  muscles  and 
surrounds  the  limb.  Above  it  is  attached  to  the  back  of  the 
sacrum  and  coccyx,  to  the  iliac  crest,  to  Poupart's  ligament, 
pubic  body  and  ramus,  ischial  tuberosity  and  ramus,  and  to 
the  lower  edge  of  the  great  sacro-sciatic  ligament.  The  tlio- 
tibial  band  is  a  thickened  part  attached  above  to  the  iliac  crest 

4 


5o  THE  POCKET  ANATOMY 

and  below  to  the  head  of  the  fibula  and  outer  tuberosity  of 
the  tibia.  The  fascia  lata  is  attached  below  to  the  head  of 
the  tibia  and  sides  of  the  patella,  being  strengthened  by 
aponeuroses  from  the  vasti  muscles.  Behind  the  fascia  passes 
across  between  the  hamstring  muscles,  enclosing  the  popliteal 
space. 

The  Saphenous  Opening.  This  is  an  aperture  in  the  fascia 
lata  in  upper  and  inner  part  of  the  thigh,  through  which  the 
internal  saphenous  vein  passes.  It  is  covered  by  the  cribri- 
form fascia.  To  describe  it,  the  fascia  is  spoken  of  as  con- 
sisting of  two  parts,  of  pubic  portion  on  the  inner  side  of  the 
opening  and  continuous  below  with  the  iliac  portion. 

The  pubic  portion  passes  up  over  the  pectineus,  adductor 
longus  and  gracilis,  and  behind  the  femoral  sheath,  blending 
externally  with  sheath  of  psoas  and  attached  internally  to  the 
pectineal  line  (Cooper ' s  ligament)  and  to  Gimbernat ' s  ligament. 

The  iliac  portion,  on  the  outer  side  of  the  saphenous 
opening,  and  covering  the  femoral  vessels,  is  attached  exter- 
nally to  the  iliac  crest,  Poupart's  ligament,  and  pubic  spine, 
joining  here  the  pubic  portion.  From  the  pubic  spine  it 
passes  down  and  out  with  a  free  margin,  the  superior  cornu  or 
falciform  process  of  Burns,  forming  the  outer  margin  of  the 
saphenous  opening,  and  becoming  continuous  below  and 
internally  with  the  pubic  portion,  the  margin  here  being  well 
defined  and  named  the  inferior  cornu. 

Sheath  of  the  Femoral  Vessels.  The  upper  part  of  the  sheath 
surrounding  the  femoral  vessels  is  called  the  crural  sheath, 
which  is  formed  by  a  prolongation  from  the  transversalis 
fascia  in  front,  and  from  the  fascia  covering  the  iliacus  behind. 
It  is  divided  into  three  compartments,  the  outer  containing 
the  artery,  the  middle  one  the  vein,  and  the  inner  one,  or 
crural  canal,  a  lymphatic  gland. 

The  crural  canal,  the  innermost  compartment  of  the  femoral 
sheath,  is  about  £  inch  long,  reaching  from  Gimbernat's  liga- 
ment to  the  saphenous  opening. 

The  upper  opening  of  the  crural  canal  is  called  the  crural 
ring,  which  is  on  a  level  with  Gimbernat's  ligament,  and  is 
closed  by  a  layer  of  sub-peritoneal  fascia,  the  septum  crurale. 

Boundaries  of  the  crural  ring  : — 

In  front,  superficial  (Poupart's  ligament)  and  deep  crural 
arches. 

Behind,  pubis,  covered  by  pectineus  ;  pubic  portion  of  fascia 
lata. 

Internallv,  Gimbernat's  ligament,  conjoined  tendon. 

Externally,  femoral  vein. 


MUSCLES  51 

The  dsep  crural  arch  is  a  thickened  bundle  of  fibres  of  the 
transversalis  fascia,  attached  to  Poupart's  ligament  outside 
the  femoral  vessels,  and  passing  across  the  femoral  sheath  to 
the  ilio-pectineal  line  behind  Gimbernat's  ligament. 

ILIAC    REGION. 

Psoas  magnus :  transverse  processes  and  sides  of  bodies 
of  all  the  lumbar  and  body  of  iath  dorsal  vertebrae(p)  (the 
fleshy  fibres  are  only  attached  to  upper  and  lower  margins 
of  bodies,  and  intervertebral  substances,  being  connected  by 
a  tendinous  arch  between) — small  trochanter  of  femur,  receiv- 
ing some  fibres  from  the  iliacus(T)  (Branches  from  lumbar 
plexus).  [A  flexes  thigh  on  trunk,  and  rotates  femur  out- 
wards; B  flexes  trunk  on  thigh.] 

Psoas  parvus :  bodies  of  i2th  dorsal  and  ist  lumbar 
vertebrae  and  intervertebral  disc(F)  —  ilio-pectineal  line(T) 
(Branch  from  lumbar  plexus).  [Flexes  lumbar  spine.]  Fre- 
quently absent. 

Iliacus  :  upper  half  of  iliac  fossa,  ilio-lumbar  ligament,  ala 
of  sacrum,  and  capsule  of  hip-joint(F) — tendon  of  psoas, 
triangular  surface  anterior  to  and  below  the  small  trochanter 
(F)  (Anterior  crural).  [A  flexes  hip-joint  and  rotates  femur 
outwards  ;  B  flexes  trunk  on  thigh.]  Passes  beneath  Poupart's 
ligament  with  the  psoas. 

ANTERIOR    FEMORAL    REGION. 

Tensor  fasciae  femoris  :  outer  edge  of  iliac  crest  for  one 
inch,  anterior  superior  iliac  spine,  and  half  notch  below  it(A) 
—fascia  lata(ilio-tibial  band)  about  £  down  thigh,  anterior  to 
great  trochanter(p)  (Superior  gluteal).  [Makes  fascia  lata 
tense,  rotates  inwards,  and  abducts  femur.] 

Sartorius  :  anterior  superior  iliac  spine  and  half  notch  below 
(A) — inner  side  of  tibia,  by  side  of  tubercle,  reaching  by  its 
upper  edge  as  far  back  as  internal  lateral  ligament(AT)  (Middle 
cutaneous  or  special  branch  from  anterior  division  of  anterior 
crural).  [Flexes  hip  and  knee,  abducts  and  rotates  thigh  out.] 
Longest  muscle  of  body,  crosses  thigh  obliquely,  forming  outer 
boundary  of  Scarpa's  triangle;  lies  over  the  roof  of  Hunter's  canal; 
lower  tendon  pierced  by  patellar  branch  of  long  saphenous  nerve. 

Quadriceps  extensor— composed  of:— 

Vastus  externus :  upper  half  of  shaft  of  femur,  thus  : — from 
base  of  neck,  anterior  and  outer  parts  of  base  of  great'  tro- 
chanter. and  line  from  great  trochanter  to  linea  aspera,  upper 
half  of  external  lip  of  linea  aspera,  external  intermuscular 

4—2 


52  THE  POCKET  ANATOMY 

septum(AF) — common  extensor  tendon,  and  slip  to  outer  side 
ofpatella(x)  (Anterior  crural). 

Vastus  internus  :  inner  lip  of  linea  aspera,  lower  part  of 
spiral  line,  tendons  of  adductores  longus  and  magnus(TA)  — 
common  tendon  and  inner  side  of  patella(x)  (Anterior  crural). 

Crureus :  upper  §  anterior  and  outer  surfaces  of  shaft  of 
femur,  lower  half  external  intermuscular  septum(p) — common 
tendon  (A)  (Anterior  crural). 

Rectus  femoris  :  ist  head.  Anterior  inferior  iliac  spine(x). 
2nd  head.  Groove  above  acetabulum(T) — common  extensor 
tendon  into  upper  border  of  patella(x)  (Anterior  crural). 

THE  COMMON  EXXENSOR  XENDON  is  inserted  into  the  upper 
and  lateral  edges  of  the  patella,  very  few  fibres  being  prolonged 
over  bone  to  help  form  the  ligamentum  patellae.  [Extends 
knee  ;  rectus  also  flexes  hip.] 

Subcrureus :  two  slips  from  anterior  surface  of  shaft  of 
femur  in  lower  fourth(p) — synovial  sac  of  knee-joint(F)  (An- 
terior crural).  [Pulls  up  synovial  expansion  of  knee-joint  in 
extension.] 

INXERNAL   FEMORAL   REGION. 

Gracilis  :  internal  margin  of  anterior  surface  of  descending 
pubic  ramus — inner  side  of  tibia  superior  to  semi-tendinosus, 
but  inferior  to  backward  prolongation  of  insertion  of  sartorius 
(x)  (Anterior  branch  of  obturator).  [Adducts  thigh,  flexes 
knee.] 

Pectineus  :  ilio-pectineal  line  and  triangular  surface  anterioi 
to  it(p) — posterior  to  small  trochanter  and  upper  half  of  line 
leading  from  it  to  linea  aspera(x)  (Anterior  crural,  and  Acces- 
sory obturator  or  Obturator).  [Adducts  thigh,  flexes  hip, 
rotates  thigh  out.] 

Adductor  longus :  anterior  surface  of  pubes  below  angle 
of  crest  and  symphysis(x) — inner  lip  of  linea  aspera(F) 
(Anterior  division  of  obturator).  [Adducts  thigh,  flexes  hip, 
rotates  thigh  out.]  Forms  internal  boundary  of  Scarpa's  triangle. 

Adductor  brevis  :  body  and  ramus  of  pubis,  extending  from 
adductor  longus  to  middle  of  ramus(FA)— behind  pectineus 
into  line  leading  from  small  trochanter  to  linea  aspera(r) 
(Obturator,  generally  anterior  branch).  [Adducts  thigh, 
flexes  hip,  rotates  thigh  out.]  Anterior  division  of  obturatornerve 
placed  in  front  and  posterior  part  behind,  the  internal  circumflex 
artery  between  upper  border  and  obturator  externus. 

Adductor  magnus  :  pubic  arch,  from  body  of  pubis  to  tuber 
ischii(A) — Anterior  part.  Line  from  great  trochanter  to  linea 
aspera,  inner  lip  of  linea  aspera,  upper  half  of  line  leading 


MUSCLES  53 

to  inner  condyle(p).  Posterior  part.  Tubercle  above  inner 
condyle(x)  (Posterior  division  of  obturator,  Great  sciatic). 
[Adducts  thigh ;  rotates  thigh  out ;  posterior  fibres  extend  hip- 
joint.]  Between  the  two  parts  of  the  muscle  there  is  an  interval,  the 
femoral  opening,  which  transmits  the  femoral  vessels. 

HUNTER'S  CANAL.  Extends  from  the  apex  of  Scarpa's 
triangle  to  the  opening  in  the  adductor  magnus,  containing 
the  superficial  femoral  vessels  and  long  saphenous  nerve.  It 
is  formed  by  aponeurotic  fibres  passing  from  the  adductores 
magnus  and  longus  to  the  vastus  internus,  and  is  covered  by 
sartorius. 

GLUTEAL    REGION. 

Gluteusmaximus :  external  surface  of  ilium  between  superior 
curved  line  and  posterior  £  of  outer  lip  of  crest,  aponeurosis 
over  erector  spinae,  posterior  surfaces  of  coccyx,  and  of 
last  2  pieces  of  sacrum,  and  great  sacro  sciatic  ligament(F) — 
gluteal  ridge  between  linea  aspera  and  great  trochanter(AF), 
fascia  lata^F)  (Inferior  gluteal).  [A,  extensor  and  rotator  out- 
wards of  thigh  ;  B,  after  stooping,  extends  trunk  on  thigh.] 

Parts  beneath  the  glutens  maximus  :  part  of  gluteus  mediua 
the  pyriformis,  superior  and  inferior  gemelli,  tendon  of 
obturator  internus,  quadratus  femoris,  upper  part  of  adductor 
magnus,  origins  of  semi-membranosus,  semi-tendinosus,  and 
biceps  and  part  of  vastus  externus.  Superficial  branch  of 
gluteal  artery  and  superior  gluteal  nerve,  sciatic  vessels,  and 
great  and  small  sciatic  nerves,  internal  pudic  vessels  and  pudic 
nerve,  nerve  to  obturator  internus,  inferior  gluteal  nerve, 
branches  of  external  and  internal  circumflex  and  ist  per- 
forating arteries.  Three  bursae,  one  over  great  trochanter, 
one  over  tuber  ischii,  one  over  vastus  externus.  Great  sacro- 
sciatic  ligament.  Great  trochanter  and  tuber  ischii. 

Gluteus  medius  :  bone  between  iliac  crest  and  superior 
curved  line  above,  and  middle  curved  line  below,  fascia(p) 
— outer  surface  of  great  trochanter  from  tip  posteriorly  to 
base  anteriorly(p)  (Superior  gluteal).  [Extends  and  abducts 
thigh  :  anterior  fibres  rotate  thigh  inwards,  posterior  out- 
wards.] Conceals  gluteal  vessels  and  nerve. 

Gluteus  minimus :  posterior  surface  of  hip-bone  between 
middle  and  inferior  curved  lines(p) — impression  on  anterior 
part  of  great  trochanter(p)  (Superior  gluteal).  [Abducts  and 
rotates  thigh  inwards.] 

Pyriformis  :  anterior  surface  of  sacrum,  from  2nd,  3rd,  and 
4th  pieces  between  anterior  foramina,  upper  margin  of  great 
sciatic  notch,  great  sacro-sciatic  ligament(p)— posterior  part 


54  THE  POCKET  ANATOMY 

of  upper  edge  of  great  trochanter(x)  (ist  and  and  Sacral). 
[Rotates  the  thigh  outwards.]  Goes  through  great  sacro-sciatic 
foramen. 

Obturator  interims  :  posterior  surfaces  of  pubic  arch,  obtu- 
rator membrane,  and  ischium  behind  ;  from  great  sciatic 
notch,  fascia(F) — front  of  upper  border  of  great  trochanter 
with  the  gemelli(T)  (Sacral  plexus).  [External  rotator  of 
thigh.]  Passes  through  small  sacro-sciatic  foramen. 

The  obturator  membrane  closes  the  thyroid  foramen,  except 
at  the  upper  and  outer  part,  where  a  canal  is  left  for  the 
obturator  vessels  and  nerve. 

Gemellus  superior :  outer  surface  of  ischial  spine(F) — 
superior  border  of  great  trochanter  anterior  to  the  pyriformis 
with  obturator  internus(x)  (Sacral  plexus).  [Rotates  thigh 
outwards.] 

Gemellus  inferior :  superior  and  outer  border  of  tuber  ischii 
(F) — superior  border  of  great  trochanter  with  obturator  in- 
ternus(T)  (Sacral  plexus).  [Rotates  thigh  outwards.] 

Obturator  externus  :  anterior  half  of  outer  surface  of  obtu- 
rator membrane,  rami  of  pubis  and  ischium(F) — digital  fossa 
at  root  of  great  trochanter(x)  (Posterior  division  of  obturator). 
[Rotates  thigh  outwards.] 

Quadratus  femoris :  external  border  of  tuber  ischii(F) — 
tubercle  on  posterior  inter-trochanteric  ridge,  and  downwards 
as  far  as  insertion  of  adductor  magnus(p)  (Sacral  plexus). 
[External  rotator  and  adductor  of  thigh.] 

POSTERIOR    FEMORAL    REGION. 

Biceps  :  Long  head.  Lower  and  inner  impression  on  tuber 
ischii,  and  great  sacro-sciatic  ligament(T).  Short  head.  Outer 
lip  of  linea  aspera  in  the  lower  half,  upper  part  of  line  to  ex- 
ternal condyle,  external  inter-muscular  septum(F) — by  two 
slips  embracing  the  external  lateral  ligament  upon  the  outer 
side  of  head  of  fibula(T)  (Great  sciatic).  [Flexes  knee  and 
extends  thigh,  rotates  leg  outwards.]  Forms  outer  hamstring. 

Semi-tendinosus :  lower  and  inner  impression  on  tuber  ischii 
with  the  biceps(x),  tendon  of  biceps(p)—  upper  part  of  internal 
surface  of  tibia,  under  cover  of  the  sartorius(x)  (Great  sciatic). 
[Extends  thigh,  flexes  knee,  and  rotates  leg  inwards.] 

Semi-membranosus  :  upper  and  outer  impression  on  the 
tuber  ischii(x) — (i)  hinder  part  of  lower  lip  of  groove  on 
internal  tibial  tuberosity(x)  beneath  internal  lateral  ligament 
• — (2)  forms  principal  part  of  posterior  ligament  of  knee — 
(3)  into  fascia  over  popliteus  (Great  sciatic).  [Extends  thigh, 
flexes  knee,  and  rotates  leg  inwards.] 


MUSCLES  55 


ANTERIOR   TIBIO-FIBULAR   REGION. 

Tibialis  anticus :  external  tuberosity  and  upper  §  of  external 
surface  of  shaft  of  tibia,  contiguous  interosseous  membrane, 
fascia  and  intermuscular  septum (F) — inner  surface  of  internal 
cuneiform ;  base  of  metatarsal  bone  of  great  toe(r)  (Anterior 
tibial).  [Flexes  ankle  and  extends  tarsal  joints,  adducts  and 
inverts  foot.]  Passes  through  innermost  compartment  of  anterior 
annular  ligament.  Outer  border  conceals  anterior  tibial  vessels. 

Extensor  proprius  hallucis  :  middle  f  of  anterior  surface  of 
shaft  of  fibula,  contiguous  interosseous  membrane(F) — base  of 
last  phalanx  of  great  toe(x)  (Anterior  tibial).  [Flexes  ankle, 
extends  tarsal  joints  and  great  toe.]  Anterior  tibial  vessels  lie 
on  the  inner  side,  but  the  tendon  crosses  to  inner  side  of  vessels  under 
anterior  annular  ligament. 

Extensor  longus  digitorum  :  external  tuberosity  of  tibia, 
head  and  upper  £  of  anterior  surface  of  shaft  of  fibula,  inter- 
osseous membrane(F) — by  four  tendons  into  the  middle  and 
last  phalanges  of  four  outer  toes(x)  (Anterior  tibial).  [Flexes 
ankle,  extends  joints  of  tarsus  and  toes.] 

Peroneus  tertius :  lower  £  of  anterior  surface  of  shaft  of 
fibula,  interosseous  membrane,  intermuscular  septum(F) — 
base  of  5th  metatarsal  on  dorsal  surface(x)  (Anterior  tibial). 
[Flexes  ankle  and  extends  tarsal  joints,  everting  the  foot.] 


POSTERIOR    TIBIO-FIBULAR    REGION,    SUPERFICIAL    LAYER. 

Gastrocnemius :  Inner  head.  Impression  on  upper  and 
posterior  part  of.  inner  condyle(T),  line  above  condyle(F). 
Outer  head.  Impression  on  external  surface  of  outer  con- 
dyle(x),  upper  and  posterior  part  of  condyle(F) — unites  with 
tendon  of  soleus  to  form  tendo  Achillis,  inserted  into  lower 
half  of  posterior  surface  of  os  calcis(T)  (Internal  popliteal). 
[Flexes  knee  and  extends  ankle.] 

Soleus  :  posterior  surface  of  head,  and  upper  J  of  posterior 
surface  of  shaft  of  fibula,  oblique  line  and  middle  £  of  internal 
border  of  tibia,  fibrous  arch  over  vessels(A) — tendo  Achillis 
(Internal  popliteal  and  posterior  tibial).  [Extends  ankle.] 
Posterior  tibial  vessels  and  nerve  lie  beneath. 

Plantaris :  line  above  outer  condyle,  posterior  ligament  of 
knee-joint(F) — tuber  calcis,  with  or  by  inner  side  of  tendo 
Achillis(x)  (Internal  popliteal).  [Flexes  knee  and  extends 
ankle.]  Tendon,  longest  in  body. 


56  THE  POCKET  ANATOMY 


POSTERIOR    TIBIO-FIBULAR    REGION,    DEEP    LAYER. 

The  FASCIA  of  the  leg  invests  the  limb  except  where  the 
inner  surface  of  the  tibia  is  subcutaneous  ;  it  is  continuous 
above  with  the  fascia  lata  of  the  thigh,  and  below  with  the 
annular  ligaments  of  the  ankle,  being  attached  in  front  to 
the  anterior  and  inner  borders  of  the  tibia,  and  to  the  antero- 
and  postero-external  borders  of  the  fibula,  forming  inter- 
muscular  septa. 

Popliteus :  anterior  half  of  impression  on  external  surface 
of  outer  condyle(T),  posterior  ligament  of  knee-joint(p) — 
triangular  space  on  posterior  surface  of  shaft  of  tibia  above 
oblique  line(p)  (Internal  popliteal).  [Flexes  knee  and  rotates 
leg  inwards.]  Forms  floor  of  popliteal  stace ;  arises  in  capsule  of 
joint  but  outside  synovial  membrane. 

Flexor  longus  hallucis :  lower  §  of  posterior  surface  of  shaft 
of  fibula,  intermuscular  septum (F) — base  of  last  phalanx  of 
great  toe(x)  (Posterior  tibial).  [Extends  ankle,  flexes  tarsal 
joints  and  joints  of  great  toe.]  Grooves  astragalus. 

Flexor  longus  digitomm :  inner  part  of  posterior  surface 
of  shaft  of  tibia,  from  oblique  line  to  3  inches  from  lower  end, 
aponeurosis  over  tibialis  posticus(F)  —four  tendons,  joined  by 
flexor  accessorius,  passing  through  slits  in  tendons  of  flexor 
brevis  digitorum,  to  bases  of  last  phalanges  of  four  outer  toes 
(T)  (Posterior  tibial).  [Extends  ankle,  flexes  joints  of  tarsus 
and  four  outer  toes.] 

Tibialis  posticus  :  posterior  surface  of  interosseous  mem- 
brane except  below,  and  aponeurosis  superficial  to  muscle, 
external  part  of  posterior  surface  of  tibia  from  head  to  2  inches 
from  lower  end,  internal  surface  of  shaft  of  fibula(r) — 
tubercle  on  scaphoid  bone,  slips  to  cuneiform,  cuboid,  bases 
of  and,  3rd,  and  4th  metatarsals,  and  sustentaculum  tali(T) 
(Posterior  tibial).  [Extends  ankle,  flexes  and  supports  tarsal 
joints,  inverts  foot.] 

FIBULAR    REGION. 

Peroneus  longus  :  upper  |  external  surface  of  shaft  of  fibula, 
fascia,  intermuscu  lar  septum(p) — outer  part  of  plantar  sur 
face  of  internal  cuneiform  and  of  base  of  ist  metatarsal(T ) 
(Musculo-cutaneous).  [Extends  ankle-joint  and  everts  foot.] 
Winds  round  grooves  behind  external  malleolus  and  outer  border  of 
cuboid  bone. 

Peroneus  brevis  :  lower  $  external  surface  shaft  of  fibula, 
intermuscular  septum(F)— projection  at  base  of  5th  meta- 
tarsal(x)  (Musculo-cutaneous).  [Extends  ankle-joint  and 
everts  foot.] 


MUSCLES  57 

THE  ANTERIOR  ANNULAR  LIGAMENT  consists  of  two  parts. 
A  superior  or  vertical  part,  attached  to  the  anterior  border  of 
the  tibia  internally,  and  to  the  anterior  border  of  the  fibula 
externally,  being  continuous  above  with  the  fascia  of  the  leg, 
and  divided  into  two  compartments,  the  internal  one  for  the 
tibialis  anticus  tendon,  which  alone  has  a  synovial  sheath, 
the  outer  one  for  the  extensor  longus  digitorum  and  peroneus 
tertius  tendons.  An  inferior  or  horizontal  part,  which  is  attached 
externally  to  the  upper  surface  of  the  os  calcis,  passes 
inwards  across  the  foot  and  divides,  the  upper  band  being 
attached  to  the  inner  malleolus,  the  lower  to  the  fascia  over 
the  foot.  It  contains  three  compartments,  with  separate 
synovial  sacs,  the  internal  one  for  the  tibialis  anticus  tendon, 
the  middle  one  for  the  extensor  proprius  hallucis  tendon, 
and  the  external  one  for  the  extensor  longus  digitorum  and 
peroneus  tertius  tendons. 

THE  INTERNAL  ANNULAR  LIGAMENT  passes  between  the 
inner  malleolus  and  the  inner  margin  of  the  os  calcis,  being 
continuous  above  with  the  deep  fascia,  and  below  with  the 
plantar  fascia.  It  is  divided  into  three  compartments.  The 
one  next  the  malleolus  transmits  the  tibialis  posticus  tendon, 
the  next  one  the  flexor  longus  digitorum,  and  the  lowest,  on 
the  astragalus,  the  flexor  longus  hallucis.  Between  these  last 
two  canals  the  posterior  tibial  vessels  and  nerve  pass  under 
the  ligament. 

THE  EXTERNAL  ANNULAR  LIGAMENT  passes  from  the  outer 
malleolus  to  the  os  calcis,  binding  down  the  peronei  tendons. 

THE  PLANTAR  FASCIA  consists  of  a  central  and  two  lateral 
parts. 

The  inner  part  covers  the  abductor  hallucis,  and  is  con- 
tinuous with  the  dorsal  fascia. 

The  outer  part  covers  the  abductor  minimi  digiti,  and  ex- 
tends from  the  external  tubercle  of  the  os  calcis  to  the  base 
of  the  5th  metatarsal. 

The  central  part  is  attached  behind  to  the  internal  tubercle 
of  the  os  calcis,  and,  extending  forwards,  splits  up  into  five 
parts  at  the  heads  of  the  metatarsal  bones,  one  part  passing 
to  each  of  the  toes. 

FOOT,  DORSAL  REGION. 

Extensor  brevis  digitorum :  superior  surface  of  os  calcis 
in  front  of  groove,  anterior  annular  ligament(F) — four  tendons, 
inner  one  to  base  of  ist  phalanx  of  great  toe,  rest  to  outer 
side  of  tendons  of  long  extensor  to  2nd,  3rd,  and  4th  toes(T) 


58  THE  POCKET  ANATOMY 

(Anterior  tibial).     [Extends  toes  and  flexes   tarsal  joints.] 
Inner  tendon  crosses  dorsalis  pedis  artery. 

FOOT,  PLANTAR  REGION,  1ST  LAYER. 

Abductor  hallucis  :  inner  side  of  large  tubercle  on  under 
surface  of  os  calcis,  plantar  fasci-a,  internal  annular  ligament 
(p)-»-inner  side  of  base  of  ist  phalanx  of  great  toe(-r)  (Internal 
plantar).  [Abducts  great  toe.] 

Flexor  brevis  digitorum  :  front  part  of  inner  tubercle  of  os 
calcis(T),  plantar  fascia(F),  intermuscular  septa(p)  —  four 
tendons,  which  on  the  ist  phalanx  divide  into  two,  allowing 
long  flexor  tendons  to  pass  through ;  the  slips  then  reunite 
and  are  inserted,  again  separating,  into  the  sides  of  the  bases 
to  middle  phalanges  of  four  outer  toes(T)  (Internal  plantar) 
[Flexes  tarsal  joints  and  first  interphalangeal  joint  of  toes.] 

Abductor  minimi  digiti:  outer  tubercle  and  fore  part  of 
inner  tubercle  of  os  calcis,  plantar  fascia,  intermuscular 
septa(r) — outer  side  of  base  of  ist  phalanx  of  little  toe 
(External  plantar).  [Abducts  little  toe.]  - 


FOOT,  PLANTAR  REGION,  2ND  LAYER. 

Flexor  accessorius :  Inner  head.  Inner  concave  surface  of 
os  calcis(p).  Outer  head.  Outer  surface  of  os  calcis  in  front 
of  outer  tubercle,  long  plantar  ligament (T) —long  flexor 
t-ndons(p)  (External  plantar).  [Flexes  toes,  correcting 
obliquity  of  pull  of  the  flexor  longus  digitorum.] 

Lumbricales :  long  flexor  tendons,  from  adjacent  sides  of 
two  tendons,  except  most  internal  one,  which  arises  from 
inner  side  of  ist  flexor  tendon (F) — inner  sides  of  bases  of  ist 
phalanx  of  four  outer  toes,  and  dorsal  expansion  of  extensor 
tendon(T)  (Internal  plantar,  ist ;  External  plantar,  2nd,  3rd, 
and  4th).  [Flex  metatarso-phalangeal  and  extend  inter- 
phalangeal joints.] 

FOOT,  PLANTAR  REGION,  3RD  LAYER. 

Flexor  brevis  hallucis:  internal  border  of  cuboid  and 
adjacent  part  of  external  cuneiform(T),  tendon  of  tibialis 
posticus(T) — outer  and  inner  sides  of  base  of  ist  phalanx 
of  great  toe(T)  (Internal  plantar).  [Flexes  great  toe  and 
adducts  it  to  middle  line  of  foot.] 

Adductor  obliquus  hallucis ;  bases  of  2nd,  3rd,  and  4th 
metatarsals,  sheath  of  peroneus  longus(p) — outer  side  of  base 
of  ist  phalanx  of  great  toe(T)  (External  plantar).  [Adducts 
great  toe.] 

Adductor    transversus    pollicis :    capsules    of   metatarso- 


ARTERIES  59 

phalangeal  joints  of  three  outer  toes(p) — outer  side  of  base  of 
ist  phalanx  of  great  toe  (x)  (External  plantar).  [Binds  toes 
together  and  adducts  great  toe.] 

Flexor  brevis  minimi  digiti :  base  of  5th  metatarsal,  sheath 
of  peroneus  longus(p) — outer  side  of  base  of  ist  phalanx  of 
little  toe(T)  (External  plantar).  [Flexes  metatarso-phalangeal 
joint  of  the  little  toe.] 


FOOT,  PLANTAR  AND  DORSAL  INTEROSSEOUS  REGION. 

Interossei  dorsales  (4) :  by  two  heads  from  adjacent  sides 
of  metatarsal  bones(p) — side  of  and  dorsal  extensor  expansion 
on  tst  phalanx  thus  :  the  inner  two  go  to  and  toe,  one  on 
each  side,  outer  two  to  outer  sides  of  3rd  and  4th  toes  respec- 
tively^) (External  plantar).  [Abduct  from  middle  line  of 
2nd  toe.] 

Interossei  plantares  (3) :  under  and  inner  surfaces  of  three 
outer  metatarsal  bones(p) — inner  side  of  base  of  ist  phalanx 
of  same  toes(T),  and  dorsal  expansion  on  ist  phalanx(T) 
(External  plantar).  [Adduct  to  middle  line  of  2nd  toe.] 


THE   ARTERIES. 

ARTERIES  OF  HEAD  AND  NECK. 

THE  SUBCLAVIAN  ARTERIES. — Extent :  Right,  from  innomi- 
nate opposite  right  sterno-clavicular  articulation.  Left,  from 
transverse  part  of  arch  of  aorta.  Both  pass  into  neck,  arching 
outwards  over  pleura;  lying  on  first  rib,  between  scalenus 
anticus  and  medius,  to  end  at  outer  border  of  it. 

Divisions :  The  scalenus  anticus,  passing  anteriorly  to  artery, 
'is 'used  to  divide  it  into  three  parts,  viz. : — 

ist  part,  from  origin  of  vessel  to  inner  border  of  scalenus 
anticus. 

2nd  part,  portion  posterior  to  scalenus  anticus. 

3rd  part,  from  outer  edge  of  scalenus  to  external  border  of 
ist  rib. 


5o 


THE  POCKET  ANATOMY 


RELATIONS    OF    THE    1ST    PART    OF    THE    RIGHT    SUBCLAVIAN. 


In  Front. 


Below. 


Behind. 


Skin. 

Internal  ju- 

Pleura.                     Pleura. 

Superficial  fascia. 
Platysma. 
Deep  fascia. 

gular 
Vertebral 
Anterior  ju- 

«5    Rscurrent  laryn-    Recurrent        \ 
•3         geal  nerve.               laryngeal 
>                                        and  cardiac 

Sterno-mas-    >   „,- 

gular 

branches  of 

toid                  JJ 
Sterno-hyoid    V  « 

Pneumogas- 
tric 

vagus. 
Sympathetic 

Sterno-thy-       1  4j 

Sympathetic 

u5                                          loop  with 

roid              ) 

loop  and 

.  >                                          lower 

Below  and  in 

superior 
cervical 

u                                         cardiac 
^                                          branches.     / 

Front. 

cardiac 

Longus  colli 

Subclavian      ^  rf 
Commence-       1   c 
mentofin-    f'% 

branch. 

muscle. 

nominate      J 

RELATIONS  OF  1ST  PART  OF  LEFT  SUBCLAVIAN. 


In  Front. 


Inner  Side. 


Behind. 


Skin. 
Superficial  fascia. 
Manubrium 

Anterior  ju-     " 
gular 
Internal  ju- 

§ 

Left  carotid. 
Trachea. 
(Esophagus. 

Longus  colli. 
(Esophagus. 
Thoracic  duct 

sterni. 

gular 

Thoracic  duct 

(below). 

Platysma. 

Left  innomi- 

> 

Pneumogastric. 

Inferior  cervical 

Deep  fascia. 

nate 

Lower  cardiac 

ganglion. 

Sterno-mas-     ^    . 

Vertebral 

branches  of 

Cord  of  sympa- 

toid                  JJ 
Sterno-hyoid    V  " 

Left  phrenic    " 
Left  vagus 

i 

sympathetic. 
Left  recurrent 

thetic. 
Pleura. 

Sterno-thy-       I  M 
roid               J  * 

Sympathetic 
loop 

% 

laryngeal 
nerve. 

Outer  Side  and 

Left  common 

Thoracic   duct 

Behind. 

carotid  artery. 

(above). 

Left  lung. 

Pleura. 

RELATIONS   OF   2ND    PART   OF    SUBCLAVIAN. 


In  Front. 

Behind.                   Below 

Skin. 

Subclavian  vein 

Pleura  and  lung.    Pleura. 

Superficial  fascia. 
Platysma. 
Deep  fascia. 

(below  level). 
Phrenic  nerve  (on 
right  side). 

Above. 
Brachial  plexus. 

Sterno-mas-    ^  ^ 

toid  (clavi-    1  J" 

cular  origin)  V  & 

Scalenus  anti-  1  £ 

ARTERIES  61 

RELATIONS  OF  3RD  PART  OF  SUBCLAVIAN. 

Contained  in  subclavian  triangle,  and  enclosed  in  tube  01 
deep  cervical  fascia. 

lit  Front.  Below. 

Skin.  Supra-scapular  artery.  ist  rib. 

Superficial  fascia.  Clavicle. 

Descending  cutaneous  Subclavius.  tientnd. 

branches  of  cervical  Nerve  to  subclavius.  Scalenus  medius. 

plexus.  Lowest  bracliial 

Platysma.  Above.  aerve  trunk. 

Deep  fascia.  Brachial  plexus. 

External  jugular         - 
Subclavian 
Branch  from  cephalic 

to  external  jugular 
Supra-scapular 
Transverse  cervical 
Anterior  jugular 

BRANCHES  FROM  THE  IST  PART. 

VERTEBRAL  :  from  upper  and  back  part.  Passes  upwards 
and  backwards,  behind  inferior  thyroid  artery  and  internal 
jugular  and  vertebral  veins,  then  between  scalenus  anticus 
and  longus  colli,  to  enter  foramen  in  transverse  process  of  6th 
cervical  vertebra.  Ascends  in  corresponding  foramina  as  far 
as  axis,  having  vertebral  vein  in  front,  and  cervical  nerves 
behind.  It  then  passes  outwards  and  upwards,  through 
foramen  in  atlas,  and  winds  backwards  and  inwards  in  verte- 
bral groove  of  atlas,  lying  on  the  floor  of  the  suboccipital 
triangle,  having  the  trunk  of  the  ist  cervical  nerve  beneath  it, 
and  the  posterior  branch  of  same  nerve  crossing  it  behind. 
It  pierces  posterior  occipito-atloid  ligament  and  dura  mater, 
and  enters  skull  through  foramen  magnum.  It  then  winds 
round  bulb,  passing  between  hypoglossal  and  anterior  root 
of  ist  cervical  nerve  to  front  of  medulla,  uniting  with  fellow, 
to  form  the  basilar  artery  (p.  73),  at  the  lower  border  of  the 
pons. 

Cervical  Branches : — 

Lateral  spinal :  each  enters  spinal  canal  through  an  inter- 
vertebral  foramen,  dividing  into  posterior  to  supply  cord  and 
membranes,  and  anterior  to  supply  bodies  of  vertebrae. 

Muscular  :  to  deep  cervical  muscles. 

Cranial  Branches  : — 

Posterior  meningeal :  arises  before  vertebral  pierces  dura 
mater  opposite  foramen  magnum,  to  falx  cerebelli.  and  dura 
in  posterior  fossa 


62  THE  POCKET  ANATOMY 

Posterior  spinal :  arises  opposite  posterior  part  of  medulla, 
passes  down  back  of  cord  behind  roots  of  nerves,  anasto- 
mising  with  spinal  branches  coming  through  intervertebral 
foramina. 

Anterior  spinal :  given  off  near  end  of  artery,  descends  in 
front  of  medulla,  unites  with  opposite  fellow  just  below  fora- 
men magnum  to  form  a  single  artery,  which  is  continued 
along  the  cord,  anastomosing  like  the  posterior  artery  ;  sup- 
plies pia  mater  and  cord. 

Posterior  inferior  cerebellar  :  arising  near  pons,  passes 
backwards  and  outwards  between  roots  of  hypoglossal  and 
then  between  spinal  accessory  and  pneumogastric  nerves,  to 
reach  under  surface  of  cerebellum  ;  divides  into  two  branches, 
one  continuing  backwards  in  sulcus  between  two  hemispheres, 
the  other  outwards  to  supply  under  surface  of  cerebellum ; 
anas,  superior  cerebellar.  Supplies  hemisphere,  vermiform 
process,  and  choroid  plexus  of  4th  ventricle. 

Bulbar  arteries  enter  medulla. 

THYROID  AXIS  :  a  short  thick  trunk  from  front  of  artery  near 
scalenus  anticus,  quickly  dividing  into : — 

Inferior  thyroid  :  passes  upwards  on  vertebral  artery  and 
under  internal  jugular  vein  ;  then  inwards  and  downwards 
behind  sheath  of  carotid  and  sympathetic  (middle  cervical 
ganglion),  finally  outwards  and  upwards  to  under  part  of  thy- 
roid body  ;  anas,  opposite  fellow  and  superior  thyroid. 

Branches : — 

Ascending  cervical:  arises  as  inferior  thyroid  turns  behind 
carotid  sheath,  ascends  parallel  to  phrenic  nerve  and  between 
scalenus  anticus  and  rectus  anticus  major,  supplying  them, 
the  cord  and  its  membranes. 

Inferior  laryngeal :  upwards  on  trachea  to  back  of  larynx, 
with  recurrent  laryngeal  nerve. 

Tracheal :  to  trachea  ;  anas,  bronchial. 

CEsophageal :  to  supply  resophagus. 

Thyroid :  to  gland. 

Muscular. 

Supra- scapular :  runs  downwards  at  first,  over  scalenus 
anticus  and  phrenic  nerve,  crosses  3rd  part  of  subclavian, 
then  runs  transversely  outwards,  behind  and  parallel  to 
clavicle,  to  upper  edge  of  scapula  under  cover  of  trapezius ; 
inclining  downwards  with  nerve  to  pass  over  transverse  liga- 
ment on  supra-scapular  notch,  enters  supra-spinous  fossa  in 
contact  with  the  bone  beneath  supra-spinatus,  which  it  sup- 
plies. It  then  winds  over  neck  of  scapula  to  infra-spinous 
fossa  ;  anas,  with  posterior  scapular  and  dorsalis  scapulae. 


ARTERIES  63 

Branches : — 

Muscular:  to  neighbouring  muscles,  ^ecially  sterno- 
mastoid. 

Supra-acromial :  through  trapezius  to  acromion ;  anas,  acro- 
mio-thoracic. 

Subscapular :  arises  as  suprascapular  passes  over  notch  ; 
anas,  in  subscapular  fossa  with  posterior  scapular  and  sub- 
scapular  of  axillary. 

Injra-spinous :  descends  on  neck  of  scapula  to  fossa ;  anas. 
dorsal  of  subscapular  and  posterior  scapular. 

Articular:  to  shoulder-joint.     Nutrient:  to  scapula. 

Transverse  cervical :  over  scaleni  muscles,  phrenic  nerve, 
and  brachial  plexus,  under  omohyoid,  to  outer  edge  of  levator 
anguli  scapulae,  there  dividing  into  : — 

Superficial  cervical :  ascends  beneath  anterior  edge  of  tra- 
pezius, supplying  it  together  with  glands,  integuments  and 
muscles  of  that  region  ;  anas,  superficial  branch  of  arteria 
princeps  cervicis. 

Posterior  scapular :  backwards  to  superior  angle  of  scapula 
beneath  levator  anguli  scapula?,  then  downwards  along  verte- 
bral border  of  scapula  under  the  rhomboids  supplying  sur- 
rounding muscles ;  anas,  supra-scapular,  subscapular. 

INTERNAL  MAMMARY:  from  under  surface  of  suDclavian  just 
below  thyroid  axis,  runs  down  behind  clavicle  and  subclavian 
vein  to  posterior  surface  of  ist  costal  cartilage,  being  crossed 
here  by  phrenic  nerve;  downwards  between  pleura  and  costal 
cartilages,  crossed  by  intercostal  nerves  and  lying  on  tri- 
angularis  sterni  as  far  as  the  6th  space,  there  dividing  into 
two  terminal  branches. 

Branches  : — 

Comes  nervi  phrenici  (superior  phrenic) :  arises  high  in  chest, 
accompanies  phrenic  nerve  between  pleura  and  pericardium 
to  diaphragm,  supplying  it;  anas,  musculo-phrenic,  inferior 
phrenic. 

Mediastinal :  to  areolar  tissue  of  anterior  mediastinum  and 
thymus  gland. 

Pericardiac :  to  upper  part  of  pericardium. 

Sternal :  to  triangularis  sterni  and  sternum. 

A  nterior  Intercostal :  to  upper  five  or  six  intercostal  spaces, 
two  in  each  space  ;  anastomose  with  aortic  intercostal. 

Perforating :  perforate  upper  five  or  six  intercostal  spaces  to 
supply  pectoral  muscles  and  mammary  gland. 

Musculo-phrenic :  external  of  two  terminal  branches  per 
forates  diaphragm  about  gth  intercostal  space,  supplying  dia- 
phragm, and  branches  to  lower  intercostal  spaces. 


<>4  THE  POCKET  ANATOMY 

Superior  epigastric :  internal  terminal  branch  passes  behind 
yth  costal  cartilage  and  pierces  diaphragm,  lies  posterior  to 
rectus  within  the  sheath,  terminating  in  that  muscle;  anas. 
deep  epigastric  of  external  iliac. 


BRANCH  FROM  THE  2ND  PART. 

SUPERIOR  INTERCOSTAL  :  from  upper  and  back  part  behind 
scalenus  anticus,  bends  backwards  over  pleural  dome  in  front 
of  neck  of  ist  rib  to  ist  and  2nd  intercostal  spaces,  supplies 
small  branches  to  cord  and  deep  spinal  muscles.  On  the 
neck  of  the  ist  rib,  the  ist  intercostal  nerve  is  external,  and 
ist  thoracic  ganglion  of  sympathetic,  internal  to  artery. 

Branch : — 

Deep  cervical :  corresponds  to  posterior  branch  of  an  aortic 
intercostal ;  passes  between  transverse  process  of  yth  cervical 
vertebra  and  ist  rib,  ascending  beneath  complexus  to  axis ; 
anas,  vertebral,  and  deep  branch  of  arteria  princeps  cervicis 
of  occipital. 

THE   COMMON    CAROTID   ARTERY. 

THE  COMMON  CAROTID  ARTERY  :  On  the  right  side,  arises 
from  the  innominate,  at  its  bifurcation  behind  the  right 
sterno-clavicular  articulation.  On  the  left  side,  from  the 
highest  or  transverse  part  of  aortic  arch,  and  is  consequently 
longer  than  the  right  artery,  and  more  deeply  placed  in  the 
thorax  at  its  origin.  It  ascends  obliquely  to  the  neck. 

Relations  of  the  Left  Common  Carotid  in  the  Thorax. 


In  Front. 

Behind. 

Left  Side. 

Skin. 
Superficial  fascia. 
Deep  fascia. 
Part  of  pectoralis 

Sterno-hyoid  and 
Sterno-thyroid 
muscles. 
Left  innominate 

Trachea. 
(Esophagus. 
Thoracic  duct. 
Left  recurrent 

Left  subclavian 
artery. 
Left  pneuraogas- 
tric  and  phrenic 

major, 
ist  piece  of  ster- 

vein. 
Thymus  gland. 

laryngeal 
nerve. 

nerves. 
Left  pleura  and 

num. 

Right  Side. 

lung. 

Innominate 

artery. 

Extent. — In  the  neck  the  common  carotid  of  either  side  ex- 
tends from  sterno-clavicular  articulation  to  opposite  upper 
border  of  thyroid  cartilage,  there  dividing  into  external  and 
internal  carotids. 

Course. — A  line  drawn  from  sterno-clavicular  articulation, 
to  point  midway  between  mastoid  process  ajad  angle  of  irA- 
tprior  maxilla. 


ARTERIES 


Relations  of  both  Common  Carotids  in  the  Neck. 
Crossed  about    midway  by  omo-hyoid,   and  enclosed  in 
same  sheath  of  deep  cervical  fascia  as  internal  jugular  vein 
and  pneumogastric  nerve. 


Part  below  Superior  Border  of  Omo-hyoid. 

In  Front.                                      Behind. 

Inner  Side. 

Skin. 

Internal  ju-       "" 

Scalenus  anticus. 

Trachea. 

Superficial  fascia. 
Platysma. 
Deep  fascia. 

gular    (over- 
laps    on   left 
side) 

Longus  colli. 
Inferior  thyroid 
»5         artery. 

CEsophagus. 
Recurrent  laryn- 
geal nerve. 

Sterno-mas-    \ 
ioid  (sternal  J   ^ 
origin)           1  ,« 
Sterno-hyoid    V  « 
Sterno-thy-         ,5 
roid               1  ^ 

Superior  and 
middle  thy- 
roid 
Anterior  ju- 
gular            j 
Descendens  and 

>-•—     Vertebral  artery. 
>     Sympathetic  ~\     . 
Recurrent       1   $ 
laryngeal     v  fc 
Pneumogas-   j  £ 
trie 

Thyroid  body. 
Superior  thyroid 
artery. 

Omo-hyoid      / 

communicans 
hypoglossi.                   Outer  Sid*. 

Internal  jugular. 

Pneumogastric. 

Behind. 
Rectus  capitis  anticns 
major. 
Pneumogastric  nerve. 
Sympathetic          ,, 

Inntr  Side. 
Larynx. 
Pharynx. 
Superior  thyroid  artery. 

Outer  Side.               | 
Internal  jugular. 

Part  above  Omo-hyoid. 
In  Front. 
Platysma. 
Deep  fascia. 
Sterno-mastoid. 
D«cendens  hypo- 
glossi. 

Sterno-mastoid  branch 
of  superior  thyroid. 

BRANCHES  of  the  Common  Carotid  Artery.  Terminal  only, 
viz.,  external  and  internal  carotid. 

EXTERNAL  CAROTID.  Extent. — From  bifurcation  of  com- 
mon carotid  opposite  upper  border  of  thyroid  cartilage,  to 
level  of  neck  of  condyle  of  inferior  maxilla,  there  dividing 
into  superficial  temporal  and  internal  maxillary. 

Course. — Line  of  artery  same  as  common  carotid. 


RELATIONS. 
Superficial.                                  Behind. 

Inner  Sidt. 

Skin. 

Facial 

•\ 

Pharynx. 

Pharynx. 

Superficial  fascia. 
Platysma. 
Deep  fascia. 
Sterno-mas-    ~\  «j 
toid               ha 
Digastric          J  3 
Stylo-hyoid     J  3 

Lingual 
Temporo- 
maxillary 

Hyp^glossal 

\l 

h 

Styloid  process. 
Stylo-glossus. 
Stylo-pharyn- 
geus. 
Glosso-pharyn- 
geal  nerve 
Internal    carotid 

Ramus  of  jaw. 
Stylo-maxillary 
ligament. 
Parotid  gland. 
Superior         ^j   .% 
laryngeal    I   « 
External         j   !j 

Parotid  gland- 

artery. 

laryngeal   J  f 

5 

66  THE  POCKET  ANATOMY 

Anterior  Branches  of  External  Carotid. 

Superior  thyroid  :  given  off  just  below  great  cornu  of  hyoid, 
curves  downwards  and  forwards  to  thyroid  body ;  anas,  fellow 
of  opposite  side,  inferior  thyroid. 

Branches  : — 

Muscular:  to  muscles  covering  it.  Sterna -mastoid  branch 
passes  downwards  and  outwards  across  sheath  of  common 
carotid,  supplying  sterno-mastoid  and  integument. 

Infra  hyoid  :  runs  transversely  inwards,  along  inferior 
border  of  hyoid  ;  anas,  with  opposite  fellow. 

Superior  laryngeal :  accompanies  superior  laryngeal  nerve, 
pierceo  thyro-hyoid  membrane,  supplies  muscles,  glands,  and 
mucous  membrane  of  larynx  ;  anas,  opposite  fellow. 

Crico-thyroid :  crosses  crico-thyroid  membrane  transversely  , 
anas,  opposite  fellow. 

Thyroid :  to  upper  and  anterior  part  of  gland. 

Lingual :  arises  from  anterior  part  of  artery  between  superior 
thyroid  and  facial  arteries,  curves  upwards  and  forwards  on 
middle  constrictor  to  tip  of  great  cornu  of  hyoid,  where  it  is 
crossed  by  hypoglossal  nerve,  thence  forwards  under  hyo- 
glossus  muscle,  digastric  and  stylo-hyoid,  parallel  with  hypo- 
glossal  nerve,  finally  on  genio-hyo-glossus  upwards  and  for- 
wards to  tip  of  tongue  as  ranine. 

Branches : — 

Supra-hyoid :  along  superior  border  of  hyoid,  supplying 
muscles,  etc. ;  anas,  opposite  fellow. 

Dorsalis  lingua:  ascends  to  dorsum  of  tongue;  anas,  oppo- 
site fellow,  supplies  mucous  membrane,  tonsil,  epiglottis, 
soft  palate,  etc. 

Sublingtial :  runs  forwards  and  outwards  to  supply  sub- 
lingual  gland,  adjacent  muscles  and  mucous  membrane. 

Ranine  :  continuation  of  the  lingual  to  tip  of  tongue,  accom- 
panies gustatory  nerve ;  anas,  opposite  fellow. 

Facial :  arises  near  angle  of  inferior  maxilla,  directed  for- 
wards and  upwards  beneath  digastric  and  stylo-hyoid  muscles 
in  groove  on  deep  surface  of  submaxillary  gland  to  base  of 
lower  jaw,  over  which  it  ascends  to  face,  being  anterior  tc 
masseter  muscle ;  ascending  to  inner  canthus,  imbedded  in 
levator  labii  superioris  alaeque  nasi,  where  it  takes  name  of 
angular,  it  rests  successively  upon  lower  jaw,  buccinator,  and 
levator  anguli  oris,  with  vein  to  outer  side,  and  crossed  by 
platysma,  risorius,  zygomaticus  major,  and  sometimes  by  the 
levator  labii  superioris ;  anas,  ophthalmic 


ARTERIES  67 

Cervical  Branches : — 

Ascending  or  inferior  palatine  :  between  stylo-glossus  and 
stylo-pharyngeus  to  pharynx  near  border  of  internal  ptery- 
goid  muscle ;  after  supplying  muscles,  tonsil,  Eustachian 
tube,  divides  near  levator  palati  into  two  branches,  one  going 
to  supply  soft  palate,  glands,  etc. ,  the  other  to  tonsil ;  anas. 
tonsillar  and  artery  of  opposite  side. 

Tonsillar :  penetrates  superior  constrictor  of  pharynx  to 
supply  tonsil  and  root  of  tongue;  anas,  ascending  palatine. 

Submaxillary  (three  or  four)  to  supply  submaxillary  gland. 

Submental :  arises  as  artery  turns  round  base  of  jaw,  and 
runs  forwards  over  mylo-hyoid,  supplying  it  and  digastric, 
then  to  symphysis,  there  dividing  into  superficial,  which  turns 
round  chin ;  anas,  inferior  labial  and  mental,  and  a  deep 
branch  perforates  mylo-hyoid,  supplying  deep  muscles  ;  anas. 
sublingual. 

Facial  Branches : — 

Muscular :  to  masseter,  buccinator,  etc. 

Inferior  labial :  runs  beneath  depressor  anguli  oris,  to  supply 
lower  lip  ;  anas,  inferior  coronary,  submental,  mental. 

Inferior  coronary  :  arises  near  angle  of  mouth,  tortuous  course 
between  mucous  membrane  of  lower  lip  and  orbicularis  oris  ; 
anastomoses  with  opposite  fellow. 

Superior  coronary  :  arises  with  or  near  preceding,  having 
corresponding  course  in  upper  lip  ;  anastomoses  with 
opposite  fellow,  supplies  a  branch,  artery  of  septum,  to  collu- 
mella  of  nose. 

Lateral  nasal :  turns  inwards  beneath  levator  labii  superioris 
alaeque  nasi  to  supply  ala  and  dorsum  of  nose  ;  anas,  opposite 
fellow,  nasal  of  ophthalmic,  and  infra-orbital. 

Angular:  terminal  branch;  anastomoses  at  inner  canthus 
with  nasal  of  ophthalmic. 

Posterior  Branches  of  External  Carotid : — 

Occipital :  arising  from  the  posterior  part  of  artery,  about 
opposite  the  facial,  runs  upwards  and  backwards  beneath 
digastric,  stylo-hyoid,  sterno-mastoid,  splenius,  and  trachelo- 
mastoid  to  interval  between  transverse  process  of  atlas  and 
mastoid  process,  then  backwards  in  the  occipital  groove,  and 
lying  on  rectus  capitis  lateralis,  superior  oblique  and  com- 
plexus  ;  lastly,  piercing  the  trapezius  near  insertion,  it  ascends 
in  company  with  the  great  occipital  nerve  to  the  back  of 
scalp.  Hypoglo^al  nerve  hooks  round  it  at  origin,  and 
the  artery  crosses  in  the  neck  the  internal  carotid  artery, 
pneumogastric  and  spinal  accessory  nerves  and  internal 
jugular  vein. 

5—2 


68  THE  POCKET  ANATOMY 

Branches  :— 

Muscular  to  digastric,  stylo-hyoid  ;  stcrno-mastoid  branch  to 
supply  that  muscle. 

Mastoid :  through  mastoid  foramen  to  dura  mater. 

Posterior  meningeal:  ascends,  in  company  with  internal 
jugular  vein,  through  jugular  foramen  to  dura  mater  in 
posterior  fossa. 

Cervical  (ramus  princess  cervicis) :  at  outer  border  of  corn- 
plexus  ;  descends  at  back  of  neck ;  superficial  branch  passes 
beneath  splenius,  supplying  it  and  the  trapezius,  anas. 
superficial  cervical ;  deep  branch,  goes  beneath  complexus, 
anas,  vertebral,  deep  cervical  of  superior  intercostal. 

Cranial :  to  muscles  and  integuments  of  occiput ;  anas. 
opposite  fellow,  posterior  auricular  and  superficial  tem- 
poral. 

Posterior  auricular :  arises  opposite  apex  of  styloid  process, 
ascends  in  parotid  to  groove  between  pinna  and  mastoid  pro- 
cess, dividing  into  anterior  or  auricular,  anas,  posterior  division 
of  temporal ;  and.  posterior  or  mastoid,  anas,  occipital.  Joined 
near  mastoid  process  by  posterior  auricular  branch  of  the  7th 
nerve. 

Branches : — 

Stylo-mastoid :  enters  stylo-mastoid  foramen,  supplying  tym- 
panum, mastoid  cells,  etc. 

Auricular :  to  posterior  part  of  concha. 

Ascending  branch  of  External  Carotid : — 

Ascending  Pharyngeal :  smallest  branch,  arising  half  an 
inch  above  origin  of  trunk,  ascends  between  internal  carotid 
and  pharynx  to  base  of  skull. 

Branches : — 

Prevertebral :  to  rectus  anticus,  ist  cervical  ganglion,  and 
gth,  loth  and  nth  nerves,  glands,  etc. 

Pharyngeal  (three  or  four) :  inwards  to  pharynx,  supplying 
constrictors,  Eustachian  tube,  and  a  palatine  branch  to  soft 
palate  and  tonsil. 

Meningeal :  one  through  foramen  jugulare,  another  through 
anterior  condylar  foramen,  and  a  third  through  foramen 
lacerum  medium  to  supply  dura  mater. 

Terminal  Branches  of  External  Carotid : — 

Superficial  temporal :  smaller  of  two  terminal  branches, 
continues  in  the  line  of  external  carotid.  Imbedded  at  first 
in  parotid,  crosses  over  root  of  zygoma  in -front  of  auriculo- 
temporal  nerve,  upwards  under  skin  fora  inches,  dividing  intq 
two  terminal  branches. 


ARTERIES  69 

Branches : — 

Parotid  to  gland. 

Transverse  facial :  arises  in  parotid,  accompanies  transverse 
branches  of  facial  nerve  and  parotid  duct  across  face,  lies 
above  the  duct,  supplying  muscles,  glands,  etc. ;  anas,  facial, 
infra-orbital. 

Middle  temporal :  arises  just  above  zygoma,  perforates  tem- 
poral fascia,  supplying  muscle  ;  anas,  deep  temporal. 

Orbital  (may  come  from  middle  temporal) :  along  zygoma 
between  layers  of  temporal  fascia  to  outer  can  thus. 

Anterior  auricular :  to  anterior  portion  of  external  ear ;  anas. 
posterior  auricular. 

A  nterior  temporal :  one  of  terminal  branches,  ascends  over  tero  - 
poralfascia,  supplying  muscles,  etc.;  anas,  frontal,  supra- orbital. 

Posterior  temporal:  curves  backwards  over  temporal  fascia 
and  inosculates  with  opposite  fellow;  anas,  posterior  auricular, 
occipital. 

Internal  maxillary :  larger  of  terminal  branches,  arises  in 
parotid,  at  first  (maxillary  portion)  curving  forwards  between 
jaw  and  internal  lateral  ligament,  parallel  with  auriculo- 
temporal  nerve  and  lying  on  internal  pterygoid  muscle  and 
inferior  dental  nerve,  then  (pterygoid  portion)  forwards  and 
outwards  on  outer  (frequently  on  inner)  surface  of  lower  head 
of  external  pterygoid,  finally  (spheno  -  maxillary  portion) 
enters  spheno-maxillary  fossa  between  two  heads  of  origin 
of  external  pterygoid. 

Branches  from  Maxillary  portion  : — 

Tympanic :  enters  Glaserian  fissure,  supplies  tympanum, 
and  membrana  tympani,  generally  gives  off  deep  auricular  to 
external  auditory  meatus  ;  anas,  vidian,  stylo-mastoid.  (May 
come  from  middle  meningeal.) 

Middle  or  great  meningeal :  arises  between  internal  lateral 
ligament  and  neck  of  conclyle,  passes  between  two  roots  of 
auriculo-temporal  nerve,  through  foramen  spinosum  of  the 
sphenoid,  dividing  on  great  wing  of  sphenoid  into  anterior  and 
posterior  branches  ;  anterior  going  to  anterior  inferior  angle  of 
parietal,  posterior  to  squamous  of  temporal ;  anas,  opposite 
fellow,  anterior  and  posterior  meningeal.  The  trunk  of  the 
artery  gives  off  Gasserian,  to  ganglion.  Petrosal :  enters 
hiatus  Fallopii ;  anas,  stylo-mastoid  of  posterior  auricular. 
Orbital :  through  sphenoidal  fissure  to  orbit.  Temporal : 
through  foramen  in  bone  to  join  branches  from  deep  temporal. 

Small  meningeal :  through  foramen  ovale,  supplies  Gasserian 
ganglion  and  dura  mater.  (Generally  a  branch  of  the  middle 
meningeal.) 


7o  THE  POCKET  ANATOMY 

Inferior  dental:  descends  with  and  behind  inferior  dental 
nerve  through  dental  foramen  on  inner  side  of  ramus  of 
inferior  maxilla,  divides  opposite  ist  bicuspid  into  incisor  and 
mental,  the  former  going  to  incisor  teeth ;  anas,  opposite 
fellow  :  the  latter  comes  out  through  mental  foramen  ;  anas. 
sub-mental,  inferior  labial,  inferior  coronary.  Mylo-hyoid 
branch  given  off  as  artery  enters  dental  foramen,  runs  in  mylo- 
hyoid  groove  to  muscle.  Lingual  branch  accompanies  lingual 
nerve. 

Branches  from  Pterygoid  portion : — 

Deep  temporal  (2) :  anterior  and  posterior  to  temporal  fossa 
between  muscle  and  cranium ;  anas,  other  temporal,  lachrymal 
through  foramina  in  malar  bone. 

Pterygoid  :  to  pterygoid  muscles. 

Masseteric :  passes  over  sigmoid  notch  to  deep  surface  of 
masseter  ;  also  supplies  temporo-maxillary  articulation. 

Buccal:  runs  forward  with  buccal  nerve  between  internal 
pterygoid  and  jaw  to  buccinator;  anas,  facial. 

Branches  of  Spheno-M  axillary  Portion  : — 

Posterior  superior  dental,  or  alveolar  :  given  off  as  artery 
passes  into  spheno-maxillary  fossa ;  descends  on  posterior 
aspect  of  maxilla  with  branch  of  superior  maxillary  nerve, 
enters  posterior  dental  canals,  supplying  molars,  bicuspids, 
antrum,  gums,  etc. 

Infra-orbital:  continuation  of  trunk,  accompanies  superior 
maxillary  nerve  through  infra-orbital  canal,  appearing  on 
face  beneath  levator  labii  superioris  ;  anas,  facial  and  buccal. 
In  the  canal  it  gives  off  branches  to  orbit,  and  an  anterior 
dental  branch  goes  with  nerve  to  supply  front  teeth ;  anas. 
posterior  dental.  On  the  face  it  supplies  lachrymal  sac  and 
inner  canthus  ;  anas,  ophthalmic  ;  and  gives  branches  down- 
wards ;  anas,  transverse  facial,  buccal  and  facial. 

Descending,  or  superior  palatine :  through  posterior  palatine 
canal  with  large  palatine  nerve,  along  hard  palate,  and 
through  foramen  of  Stenson  in  anterior  palatine  fossa ;  anas. 
artery  of  septum  from  facial  and  naso-palatine. 

Vidian :  through  vidian  canal  with  nerve,  supplies  Eusta- 
chian  tube  and  tympanum. 

Pterygo-palatine  :  backwards  through  pterygo-palatine  canal 
with  pharyngeal  nerve  to  upper  part  of  pharynx. 

Nasal,  or  spheno-palatine :  enters  spheno-palatine  foramen, 
supplying  posterior  ethmoidal  cells,  etc.  Branch.  Naso-pala- 
tine or  artery  of  septum,  runs  along  vomer;  anas,  descending 
palatine. 

INTERNAL   CAROTID.     Extent. — From    superior  border  of 


ARTERIES  71 

thyroid  cartilage  to  Sylvian  fissure  of  brain,  there  dividing 
into  anterior  and  middle  cerebral. 

Course. — Extends  directly  upwards  from  common  carotid 
to  carotid  canal  of  temporal  bone ;  entering  canal  passes 
upwards,  internal  to  and  then  above  Eustachian  tube,  then 
forwards  and  inwards,  then  alongside  of  sella  Turcica  in  the 
cavernous  sinus,  having  the  6th  nerve  on  the  outer  side ;  it 
turns  upwards  on  inner  side  of  anterior  clinoid  process, 
pierces  dura  mater,  and  divides  between  and  and  3rd  cranial 
nerves  at  anterior  perforated  spot  into  branches.  No  branches 
given  off  from  cervical  part. 

RELATIONS    IN   THE   NECK. 

Superficial.  Inner  Side.  Behind. 

Skin.  Pharynx.  Internal  jugular  veil  . 

Superficial  fascia.  Ascending  pharyngeal          Rectus  capitis  anticus 

Platysma.  artery.  major. 

Deep  fascia.  Superior   and    external        Sympathetic. 

Sterno-mastoid.  laryngeal  nerves.  Pneumogastric. 

Parotid  gland. 
External  carotid. 
Digastric. 
Stylo-hyoid. 
Stylo-glossus. 
Stylo-pharyngeus. 
Occipital  )  .,,*»««*- 

Posterior  auricular  J  ar1 
Hypoglossal  \ 

Glosso-pharyngeal    l_-___ 
Pharyngeal  branch  fne 
of  vagus  J 

Outer  Side. 
Internal  jugular  vein. 

Branch  from  Petrous  portion  : — 

Tympanic :  inconstant :  through  a  foramen  in  carotid  canal 
to  tympanum ;  anas,  tympanic  of  internal  maxillary  and  stylo- 
mastoid. 

Branches  from  Cavernous  portion : — 

Pituitary :  small  branches  to  pituitary  body,  etc. 

Meningeal :  to  dura  mater  in  middle  fossa. 

Ophthalmic  :  arises  at  inner  side  of  anterior  clinoid  process, 
enters  orbit  through  optic  foramen,  external  and  below  optic 
nerve  ;  it  then  crosses  over  nerve  to  inner  angle  of  orbit  to 
divide  into  two  terminal  branches,  frontal  and  nasal. 

Branches  arising  outside  Optic  Nerve  : — 

Lachrymal :  accompanies  lachrymal  nerve  over  external 
rectus  to  lachrymal  gland,  gives  off  malar  branches ;  anas. 


72  THE  POCKET  ANATOMY 

deep  temporal  and  transverse  facial.     Branch  sent  back  to 
anas,  middle  meningeal  through  sphenoid  fissure 

Central  of  retina  :  pierces  optic  nerve,  runs  in  its  substance 
to  retina  (vide  Eye) . 

Branches  arising  over  Optic  Nerve : — 

Posterior  ciliary  :  divided  into  two  sets.  Short  (10)  perforate 
sclerotic  and  supply  choroid.  Long  (2)  pass  forward  between 
choroid  and  sclerotic;  anas,  anterior  ciliary  and  supply  iris 
and  ciliary  processes. 

Supra-orbital :  ascends  with  frontal  nerve  over  muscles,  etc., 
to  supra-orbital  foramen  ;  passing  out,  ascends  over  frontal 
bone  ;  anas,  temporal,  facial  and  frontal. 

Branches  arising  internal  to  Optic  Nerve  : — 

Muscular,  superior  and  inferior  :  to  muscles  of  orbit,  give  off 
anterior  ciliary  (6-8),  which  pierce  sclerotic  behind  cornea. 

Ethmoidal :  anterior  and  posterior  to  ethmoidal  cells,  through 
anterior  and  posterior  internal  orbital  canals  respectively, 
supplying  also  dura  mater,  the  anterior  accompanying  nasal 
nerve  to  skin  of  nose  (anterior  nasal  branch). 

Palpebral  (2) :  one  for  each  lid,  arise  near  pulley,  form  an 
arch  in  each  lid,  and  supply  lachrymal  apparatus. 

Terminal  Branches : — 

Frontal :  turns  upwards  round  inner  margin  of  orbit ;  anas. 
supra-orbital. 

Nasal :  over  tendo  oculi  to  root  of  nose ;  anas,  nasal  and 
angular  of  facial. 

Branches  from  Cerebral  Portion  of  Internal  Carotid  : — 

Anterior  cerebral :  arises  at  inner  extremity  of  fissure  of 
Sylvius,  passes  forwards  in  great  longitudinal  fissure.  Oppo- 
site arteries  united  by  anterior  communicating.  It  then  curves 
round  fore  part  of  corpus  callosum,  supplying  offsets  to  corpus 
callosum,  frontal  and  parieto-occipital  sulci,  and  to  anterior 
perforated  spot. 

Middle  cerebral:  largest  offset,  enters  fissure  of  Sylvius, 
dividing  into  branches  for  external  surface  of  hemisphere, 
and  interior  of  brain,  the  latter  entering  anterior  perforated 
spot.  Internal  branches:  Caudate,  thalamic,  and  lenticulo- 
striate.  External  branches:  Frontal,  parietal,  parieto-tem- 
poral,  and  temporal. 

Posterior  communicating:  from  posterior  part  of  artery, 
runs  backwards  ;  anas,  posterior  cerebral  of  basilar. 

Anterior  choroid :  from  back  part  of  artery,  passes 
backwards  and  outwards  to  enter  descending  horn  of 
lateral  ventricle,  just  beneath  edge  of  middle  lobe  ;  supplies 


ARTERIES  73 

hippocampus  major,  corpus  fimbriatum,  and  choroid 
plexus. 

THE  BASILAR  ARTERY  :  formed  by  union  of  the  two  ver- 
tebral arteries.  Extent,  from  lower  to  upper  border  of  pons, 
there  dividing  into  posterior  cerebrals. 

Branches : — 

Transverse  (4  or  6) :  twigs  to  supply  pons  and  internal 
auditory,  an  offset  to  internal  ear,  with  auditory  nerve. 

Anterior  inferior  cerebellar  :  backwards  to  anterior  part  of 
inferior  surface  of  cerebellum  ;  anas,  posterior  inferior  cere- 
bellar of  vertebral. 

Superior  cerebellar:  arises  near  termination,  to  upper 
surface  of  cerebellum,  winding  round  crus  cerebri  behind 
3rd  nerve  ;  anas,  opposite  fellow,  inferior  cerebellar. 

Posterior  cerebral  (2) :  one  on  each  side,  terminal  of  basilar, 
winds  backwards  round  crus  in  front  of  3rd  nerve,  passes 
upwards  to  under  surface  of  posterior  cerebral  lobes,  joined 
near  crus  by  posterior  communicating,  and  gives  off : — Postero- 
median  to  posterior  perforated  spot ;  Posterior  choroid  to  choroid 
plexus  through  transverse  fissure ;  Postero-lateral  to  optic 
thalamus ;  Cortical  branches :  temporal,  calcarine,  parieto- 
occipital ;  anas,  anterior  and  middle  cerebral. 

CIRCLE  OF  WILLIS  :  a  name  given  to  the  anastomoses 
between  the  vertebral  and  internal  carotid  arteries  at  base  of 
brain.  The  internal  carotid  sends  forward  the  anterior 
cerebrals,  which  are  connected  by  the  anterior  communi- 
cating. The  basilar  sends  forwards  the  posterior  cerebrals, 
which  are  joined  to  the  carotid  by  the  posterior  communicating 
arteries. 

ARTERIES  OF  UPPER  LIMB. 

THE   AXILLARY   ARTERY. 

Extent. — From  outer  border  of  ist  rib  to  lower  border  of 
teres  major  insertion.  Divided  into  three  parts  : — 

IST  PART.  Extent. — From  outer  border  of  ist  rib  to  upper 
border  of  pectoralis  minor. 

Relations. — In  front.  Pectoralis  major,  costo-coracoid  mem- 
brane, cephalic  vein,  external  anterior  thoracic  nerve,  and 
branches  of  acromio-thoracic  artery  and  vein. 

Behind,  ist  intercostal  space  and  muscle,  ist  serration  of 
serratus  magnus,  posterior  thoracic  nerve. 

Inner  side.  Internal  anterior  thoracic  nerve  and  axillarj 
vein.  Outer  side.  Brachial  plexus. 


74  THE  POCKET  ANATOMY 

2ND  PART.     Extent. — From  superior  to  inferior  border  oi 
pectoralis  minor. 

Relations. — In  front.     Pectorales  major  and  minor. 
Behind.     Subscapularis,  posterior  cord  of  plexus. 
Outer  side.     Outer  cord  of  plexus. 
Inner  side.     Inner  cord  of  plexus,  separating  artery  from 


3RD  PART.  Extent. — From  inferior  border  of  pectoralis 
minor  to  lower  border  of  teres  major. 

Relations.  — In  front.  Pectoralis  major,  inner  head  of  median 
and  internal  cutaneous  nerves  ;  below,  skin  and  fasciae. 

Behind.  Subscapularis,  tendons  of  latissimus  dorsi  and 
teres  major,  musculo-spiral  and  circumflex  nerves. 

Inner  side.  Uln'ar  nerve,  axillary  vein,  and  lesser  internal 
cutaneous  nerve. 

Outer  side.  Coraco  -  brachialis,  median  and  musculo- 
cutaneous  nerves. 

Branches : — 

Superior  thoracic  (ist  part) :  arises  opposite  ist  intercostal 
space,  supplies  pectorales ;  anas,  internal  mammary,  inter- 
costals. 

Acromio-thoracic  (ist  part) :  arises  from  front  of  artery 
just  above  pectoralis  minor. 

Branches : — 

Acromial :  supply  and  perforate  deltoid;  anas,  branch  of 
supra-scapular  and  posterior  circumflex. 

Humeral :  accompanies  cephalic  vein ;  anas,  anterior 
circumflex. 

Thoracic :  two  or  three  branches  to  supply  side  of  thorax  ; 
anas,  intercostal, 

Clavicular :  one  or  two  twigs  to  clavicle  and  subclavius. 

Long  thoracic  (and  part) :  passes  downwards  along  inferior 
border  of  pectoralis  minor  to  about  6th  intercostal  space, 
supplies  pectorales  and  serratus  magnus ;  anas,  intercostal 
and  other  thoracic  branches.  In  female  gives  branches  to 
mammary  gland  :  external  mammary. 

Alar  thoracic  (and  part) :  supplies  glands  and  fat  of  the 
axilla  ;  not  a  constant  separate  branch. 

Subscapular  (3rd  part) :  arises  opposite  lower  border  of 
Subscapularis  muscle,  and  courses  with  the  long  subscapular 
nerve  to  lower  angle  of  scapula. 

Branch : — 

Dorsalis  scapula :  given  off  near  origin  to  dorsum  of  scapula, 
passes  backwards  to  the  infraspinous  fossa  through  triangular 


ARTERIES  75 

interval,  bounded  above  and  internally  by  the  subscapularis, 
below  by  teres  major,  and  externally  by  the  long  head  of  the 
triceps.  In  the  triangular  interval  it  gives  off  ventral  branches 
to  subscapular  fossa,  and  a  descending  branch  which  runs  down 
between  the  two  teres  muscles  to  the  angle.  Supplies  sub- 
scapularis, latissimus  dorsi,  teres  major,  serratus  magnus ; 
anas,  supra-scapular  and  posterior  scapular. 

Posterior  circumflex  (3rd  part) :  arises  from  back  of  artery 
opposite  lower  border  of  subscapularis,  winds  backwards 
through  quadrilateral  space,  bounded  above  by  the  teres 
minor,  below  by  the  teres  major,  internally  by  the  long  head 
of  the  triceps,  and  externally  by  the  neck  of  the  humerus. 
Supplies  deltoid,  head  of  humerus,  shoulder-joint,  teres  minor, 
and  long  head  of  triceps ;  anas,  acromio  -  thoracic,  anterior 
circumflex  and  superior  profunda. 

Anterior  circumflex  (3rd  part) :  arises  from  outer  side  of 
artery,  one  branch  ascends  bicipital  groove  to  shoulder-joint, 
another  winds  round  surgical  neck  of  humerus  ;  anas,  posterior 
circumflex. 

THE    BRACHIAL   ARTERY. 

Extent. — From  lower  border  of  teres  major  to  half  an  inch 
below  bend  of  elbow,  runs  along  inner  borders  of  coraco- 
brachialis  and  biceps,  accompanied  by  venae  comites. 

Relations. — In  front.  Integument,  fascia,  coraco-brachialis, 
biceps  and  bicipital  fascia,  median  basilic  vein.  Crossed  by 
median  nerve  at  insertion  of  coraco-brachialis. 

Behind.  Long  and  inner  heads  of  triceps,  musculo-spiral 
nerve,  superior  profunda  vessels,  coraco-brachialis,  brachialis 
anticus. 

Inner  side.  Internal  cutaneous  nerve  to  about  middle  of  arm, 
r.lnar  nerve  to  insertion  of  coraco-brachialis,  median  nerve 
from  insertion  of  coraco-brachialis  to  elbow. 

Outer  side.  Coraco-brachialis  and  biceps.  Median  nerve 
from  origin  of  artery  of  insertion  of  coraco-brachialis. 

Branches : — 

Superior  profunda  :  arises  opposite  lower  border  of  teres 
major,  winds  backwards  and  outwards  with  musculo-spiral 
nerve  in  the  groove  to  triceps;  gives  off  anterior  branch 
which  pierces  external  intermuscular  septum  (anas,  radial 
recurrent) ;  and  ends  as  posterior  branch  behind  external 
condyle ;  anas,  posterior  circumflex,  interosseous  recurrent, 
anastomotic.  Supplies  triceps,  anconeus. 

Nutrient :  arises  about  middle  of  humerus,  and  enters 
medullary  foramen  near  insertion  of  coraco-brachialis. 


76  THE  POCKET  ANATOMY 

Inferior  profuuda:  arises  opposite  insertion  of  coraco- 
brachialis,  accompanies  ulnar  nerve,  pierces  internal  inter- 
muscular  septum ;  anas,  posterior  ulnar  recurrent  and  anas- 
tomotic  at  elbow. 

Anastomotica  magna:  arises  2  inches  above  elbow-joint, 
courses  to  hollow  between  olecranon  and  inner  condyle  of 
humerus;  anas,  inferior  profunda,  anterior  and  posterior  ulnar 
recurrent,  and  a  branch  across  the  back  of  olecranon  with 
superior  profunda.  Supplies  elbow-joint. 

Muscular :  to  coraco-brachialis,  biceps,  brachialis  anticus. 

THE   RADIAL   ARTERY. 

Extent. — From  bifurcation  of  the  brachial  to  ending  of  the 
deep  palmar  arch  of  hand ;  accompanied  by  venae  comites. 

Relations  in  the  forearm. — In  front.  Integument,  fascia, 
supinator  longus. 

Behind.  Tendon  of  biceps,  supinator  brevis,  pronator  radii 
teres,  flexores  sublimis  digitorum  et  longus  pollicis,  pronator 
quadratus,  lower  end  of  radius. 

Inner  side.  Pronator  radii  teres,  flexor  carpi  radialis. 

Outer  side.  Supinator  longus  tendon,  and  for  middle  £rd, 
radial  nerve. 

The  artery  courses  along  inner  border  of  supinator  longus 
tendon  to  carpus,  winds  round  carpus  beneath  extensors  of 
thumb  and  radial  nerve,  lying  on  external  lateral  ligament  of 
wrist,  scaphoid  and  trapezium,  enters  palm  of  hand  through 
the  heads  of  the  ist  dorsal  interosseous  muscle,  forming  deep 
palmar  arch. 

Branches : — 

Radial  recurrent:  arises  just  below  elbow,  ascends  to 
between  brachialis  anticus  and  supinator  longus,  supplying 
them  and  the  elbow-joint ;  anas,  superior  profunda. 

Muscular  :  to  muscles  attached  to  radial  side  of  forearm. 

Superficial  volar  :  arises  when  the  artery  is  about  to  wind 
round  carpus,  passes  between  muscles  of  ball  of  thumb;  anas. 
with  ulnar,  completing  superficial  palmar  arch. 

Anterior  carpal :  arises  near  lower  border  of  pronator 
quadratus,  passes  inwards  under  tendons ;  anas,  anterior 
carpal  of  ulnar. 

Posterior  carpal :  arises  beneath  extensor  tendons  of  thumb  : 
mas.  posterior  carpal  of  ulnar,  forming  posterior  carpal  arch , 
which  gives  off  2nd  and  3rd  dorsal  interosseous  to  3rd  and  4th 
spaces ;  and  anas,  with  superior  perforating  of  deep  arch,  and 
at  lower  end  of  interosseous  space  gives  off  inferior  per- 
forating to  join  palmar  digital  arteries. 


ARTERIES  77 

Metaearpal  (ist  dorsal  interosseous) :  arises  near  or  with 
the  posterior  carpal ;  anas,  superior  perforating  of  deep  arch, 
digital  of  superficial  arch ;  supplies  adjoining  sides  of  index 
and  middle  fingers. 

Dorsalis  pollicis  (2) :  arising  near  base  of  ist  metacarpal, 
course  along  sides  of  dorsum  of  thumb. 

Dorsalis  indicis  :  courses  along  radial  side  of  dorsum  of 
index,  supplying  abductor  indicis. 

Princeps  pollicis  :  arising  as  the  artery  enters  palm,  courses 
between  ist  metacarpal  and  abductor  obliquus  pollicis  to  the 
base  of  ist  phalanx,  where  it  divides  into  two  terminal 
branches,  which  run  along  the  sides  of  the  palmar  surface  of 
thumb. 

Radialis  indicis  :  arising  near  the  preceding,  passes  between 
ist  dorsal  interosseous  and  adductor  transversus  pollicis  to 
outer  side  of  index-finger,  sends  a  branch  to  superficial  palmar 
arch  ;  anas,  digital  of  superficial  arch. 

Deep  palmar  arch :  Extent,  from  upper  end  of  ist  interos- 
seous space  to  base  of  5th  metacarpal.  It  lies  over  the  bases 
of  the  metacarpal  bones,  and  terminates  by  inosculating  with 
the  deep  branch  of  the  ulnar. 

Branches : — 

Recurrent :  to  front  of  carpus  ;  anas,  carpal  arteries. 

Palmar  interossei  (3)  :  in  the  three  inner  interosseous  spaces 
join  digital  of  superficial  arch  at  cleft  of  fingers,  and  an  offset 
from  inner  branch  joins  digital  branch  to  inner  side  of  5th 
finger. 

Superior  perforating :  pierce  three  inner  dorsal  interossei ; 
anas,  dorsal  interosseous. 


THE    ULNAR    ARTERY. 

Extent. — From  bifurcation  of  brachial  to  end  in  superficial 
palmar  arch,  coursing  along  outer  side  of  flexor  carpi  ulnaris 
to  the  palm  ;  accompanied  by  venae  comites. 

Relations  in  the  forearm. — In  front.  Pronator  radii  teres, 
flexor  carpi  radialis,  palmaris  longus,  flexor  sublimis,  median 
nerve  in  upper  half;  lower  half,  overlapped  by  flexor  carpi 
ulnaris  tendon. 

Behind,  Brachialis  anticus,  flexor  profundus  digitorum. 

Inner  side.  Flexor  carpi  ulnaris,  the  ulnar  nerve  in  the 
lower  §. 

Outer  side.  Flexor  sublimis  digitorum. 

Lies  upon  anterior  annular  ligament  at  wrist,  external  to 
the  ulnar  nerve  and  pisiform  bone. 


78  THE  POCKET  ANATOMY 

Branches : — 

Anterior  ulnar  recurrent :  arises  near  bifurcation  of 
brachial,  ascends  between  brachialis  anticus  and  pronator 
radii  teres,  supplying  them ;  anas,  inferior  p'rofunda,  anas- 
tomotic. 

Posterior  ulnar  recurrent :  arising  below  the  anterior,  passes 
beneath  flexor  sublimis,  ascends  behind  inner  condyle,  thence 
between  heads  of  flexor  carpi  ulnaris,  supplying  joint  and 
muscles  around;  anas,  inferior  profunda,  anastomotic. 

Common  interosseous :  about  half  an  inch  long,  arising  just 
below  radial  tubercle,  passes  to  interosseous  membrane,  there 
dividing  into  two  terminal  branches. 

Branches : — 

Anterior  interosseous  :  passes  down  forearm,  resting  upon 
anterior  surface  of  interosseous  membrane,  accompanied  by 
and  internal  to  interosseous  branch  of  median  nerve.  At 
upper  border  of  pronator  quadratus  one  branch,  the  anterior 
communicating,  goes  downwards  beneath  quadratus  to  anas. 
with  anterior  carpal  and  deep  arch :  the  other  piercing  in- 
terosseous membrane  descends  to  back  of  carpus  ;  anas,  pos- 
terior interosseous,  posterior  carpal  of  radial  and  ulnar. 
Supplies  nutrient  branches  to  radius  and  ulna,  and  branch  to 
median  nerve  :  comes  nervi  mediani. 

Posterior  interosseous :  passes  backwards  between  oblique 
ligament  and  interosseous  membrane,  and  between  supinator 
brevis  and  extensor  ossis  metacarpi  pollicis,  runs  down  back 
of  forearm,  lying  internal  to  posterior  interosseous  nerve, 
between  superficial  and  deep  muscular  layers  as  far  as  the 
wrist ;  anas,  posterior  carpal  of  radial  and  ulnar,  anterior 
interosseous. 

Branch : — 

Posterior  interosseous  recurrent :  given  off  near  origin,  passes 
under  anconeus  to  interval  between  olecranon  and  external 
condyle  ;  anas,  superior  profunda,  anastomotic. 

Muscular :  to  muscles  on  ulnar  side  of  forearm. 

Anterior  carpal :  courses  beneath  tendons  of  flexor  pro- 
fundus  ;  anas,  anterior  carpal  of  radial. 

Posterior  carpal :  arises  just  above  pisiform,  winds  back 
beneath  flexor  carpi  ulnaris  tendon,  gives  branch  to  inner 
side  of  5th  metacarpal,  and  then  passes  outwards  to  anas. 
with  posterior  carpal  of  radial,  forming  posterior  carpal  arch 
(vide  Radial  Artery). 

Superficial  palmar  arch  :  continues  the  ulnar  in  the  hand, 
lying  immediately  under  palmar  fascia  and  on  digital  nerves 
and  flexor  tendons.  It  turns  outwards  a  little  below  the 


ARTERIES  79 

anterior  annular  ligament,  and,  forming  an  arch  with  the  con- 
vexity downwards,  is  directed  to  the  thumb,  where  the  arch 
becomes  completed  by  joining  the  superficialis  volae,  radialis 
indicis,  or  princeps  pollicis.  From  the  convex  side  of  the 
arch  it  gives  off  four  digital  branches  to  supply  three  inner 
fingers  and  inner  side  of  index-finger ;  anas,  palmar  interossei 
of  deep  arch,  inferior  perforating  of  dorsal  interosseous. 

The  deep  branch  of  ulnar  artery  or  communicating  branch 
is  given  off  at  commencement  of  arch,  passes  down  with 
the  deep  branch  of  ulnar  nerve  between  abductor  and  short 
flexor  of  little  finger  to  complete  deep  palmar  arch. 

ARTERIES  OF  BODY. 

THE    AORTA. 

Large  main  trunk  of  systemic  arteries,  situated  partly  in 
thorax  and  partly  in  abdomen,  commences  at  left  ventricle, 
arches  over  root  of  left  lung,  descends  in  front  of  vertebral 
column,  through  diaphragm  into  abdomen,  ending  opposite 
body  of  4th  lumbar  vertebra  by  bifurcating  into  two  common 
iliacs.  Conveniently  divided  into  three  parts:  arch  of  aorta, 
descending  thoracic  aorta,  abdominal  aorta. 

ARCH  OF  AORTA  :  divided,  according  to  the  direction,  into 
ascending  and  transverse  portions.  In  the  concavity  of  the 
arch  are  contained  root  of  left  lung,  branching  of  pulmonary 
artery  with  ductus  arteriosus,  cardiac  plexuses,  left  recurrent 
laryngeal  nerve,  oesophagus  and  thoracic  duct. 

Ascending  part :  Extent  and  Course.— Two  inches  in  length. 
From  base  of  left  ventricle,  opposite  lower  border  of  3rd  left 
costal  cartilage,  passing  behind  pulmonary  artery,  upwards 
and  to  the  right,  crossing  the  posterior  surface  of  the  sternum 
obliquely,  and  extending  as  high  as  superior  border  of  2nd 
right  costal  cartilage.  At  its  root  it  presents  three  bulgings, 
the  sinuses  of  Valsalva,  and  along  the  right  side  is  a  dilatation, 
the  great  sinus  of  the  aorta. 

Relations. — Is  contained  nearly  completely  in  pericardium. 

In  Front.  Behind.  Right  Side.  Left  Sidt. 

Pulmonary  artery.       Left  auricle.  Superior  cava.       Pulmonary  ar 

Right  auricular  ap-      Right     pulmonary      Right  auricle.  tery. 

pendix.  vessels. 

Pericardium.  Root  of  right  lung. 

Right     lung     and 

pleura. 
Sternum. 


So 


THE  POCKET  ANATOMY 


Branches. — Right  and  left  coronary  arteries  distributed  to 
heart  (vide  Heart). 

Transverse  part,  which  runs  much  more  from  before  back- 
wards than  from  right  to  left,  so  that  relations  in  front  are  also 
to  the  left,  and  those  behind  to  the  right,  commences  at  upper 
border  of  2nd  right  costal  cartilage,  arching  backwards  over 
root  of  left  lung,  as  far  as  inferior  border  of  left  side  of  body  of 
4th  dorsal  vertebra. 


Relations. 

In  Front  and                  A, 
to  Left.                       Abave' 

Below. 

Behind  and  to 
Right. 

Manubrium.               Left  innominate 

Bifurcation  of  pul- 

Trachea. 

Thymus.                        vein. 

monary  artery. 

Deep   cardiac 

I  .eft    pleura    and 

Ductus  arteriosus. 

plexus. 

lung. 

Left  bronchus. 

(Esophagus. 

Left  phrenic    \ 
Inferior     car-  J 

Left  recurrent 
laryngeal  nerve. 

Thoracic  duct. 
Left  recurrent 

diac  of  left  I   j, 

laryngeal  nerve. 

vagus             1   § 
Superior    car-  f  <u 

diac  of  left    fc 

sympathetic  1 

Left  vagus       / 

Left    superior  in- 

tercostal vein. 

Branches : — 

Innominate  (i|  to  2  inches  long) :  arises  at  commencement 
of  transverse  part,  ascends  to  right  beneath  sternum,  dividing 
opposite  right  sterno-clavicular  articulation  into  right  common 
carotid  and  right  subclavian  arteries  (vide  Arteries  of  Head  and 
Neck,  pp.  59  and  64). 

Relations  of  the  Innominate. — Lies  behind  manubrium  and 
origins  of  right  sterno-hyoid  and  sterno-thyroid  muscles, 
thymus  gland  and  left  innominate  and  right  inferior  thyroid 
veins.  Trachea  at  first  behind,  but  above  to  left  side,  where 
artery  lies  on  pleura.  On  the  right  side  lie  the  right  innomi- 
nate vein  and  right  phrenic  nerve.  On  the  left  side,  below  is 
the  left  common  carotid,  above  the  trachea.  The  innominate 
occasionally  gives  off  a  branch,  the  arteria  thyroidea  ima,  which 
passes  in  front  of  trachea  to  thyroid  gland. 

Left  common  carotid  (vide  Arteries  of  Head  and  Neck,  p.  64). 

THE   DESCENDING  THORACIC   AORTA. 

Extent. — From  lower  border  of  4th  dorsal  vertebra  (left 
side)  to  aortic  opening  in  front  of  body  of  i2th  dorsal  ver- 
tebra. 


ARTERIES  8 1 

Course  and  Relations. — Lies  in  posterior  mediastinum  ;  is  at 
first  to  left  of  bodies  of  vertebrae,  but  afterwards  lies  in 
front  of  them. 

In  front.  Root  of  left  lung,  pericardium  and  diaphragm, 
crossed  by  oesophagus  at  lower  end. 

Behind.  Bodies  of  vertebrae  and  venae  azygoi  minores, 
superior  and  inferior. 

Left  side.     Left  lung  and  pleura,  oesophagus  below. 

Right  side.  (Esophagus  above,  thoracic  duct,  and  vena 
azygos  major :  right  lung  and  pleura. 

Branches : — 

Bronchial :  supply  structure  of  lungs.  For  the  left  lung  two 
branches  come  off  from  front  of  aorta  (superior  and  inferior). 
The  artery  supplying  right  lung  arises  either  with  or  from 
superior  left  branch,  or  from  first  right  aortic  intercostal. 

Pericardial :  small  twigs  to  posterior  surface  of  pericar- 
dium. 

(Esophageal  (4  or  5)  :  from  front  of  aorta,  running  obliquely 
downwards  to  supply  oesophagus ;  anas,  with  one  another, 
inferior  thyroid  and  coronary  of  stomach. 

Posterior  mediastinal :  supply  glands,  etc.,  of  posterior 
mediastinum. 

Intercostal  (9  pairs)  :  arise  from  posterior  part  of  aorta, 
run  transversely  outwards  on  bodies  of  vertebrae,  and  behind 
pleura  to  intercostal  spaces.  The  right  ones,  crossing  over 
front  of  spine,  supply  the  bodies  of  vertebrae,  and  pass  behind 
oesophagus,  thoracic  duct,  and  azygos  veins.  The  arteries  of 
both  sides  are  crossed  by  sympathetic  chain  and  its  splanch- 
nic branches.  On  reaching  intercostal  spaces,  they  divide 
into  anterior  and  posterior  branches ;  the  anterior  branch 
crosses  the  space  obliquely  upwards  so  as  to  get  to  lower 
border  of  the  upper  rib  near  the  angle :  at  first  it  lies  between 
external  intercostal  and  fascia,  subsequently  between  two 
intercostal  muscles  ;  anas,  anterior  intercostal  of  internal 
mammary,  thoracic  branches  of  axillary.  Above  the  artery 
is  a  companion  vein,  and  below  the  intercostal  nerve.  A 
branch,  the  collateral  intercostal,  is  given  off  near  the  angle  of 
the  rib,  which  runs  along  the  upper  border  of  the  lower  rib ; 
anas,  anterior  intercostal.  Branches  accompany  the  lateral 
cutaneous  nerves  of  the  thorax  from  the  main  trunks  of  the 
intercostals.  The  three  lower  branches  pass  forwards  between 
muscles  of  abdominal  wall ;  anas,  epigastric  and  lumbar. 

The  posterior  branch  passes  backwards  between  vertebra 
and  superior  costo- transverse  ligament,  sending  inwards,  spinal 
branch  through  intervertebral  foramen  to  cord,  membranes 

6 


82  THE  POCKET  ANATOMY 

and  body  of  vertebra,  and  backwards,  muscular  branch  which 
divides  into  inner  and  outer  branches  to  muscles  of  back. 

(The  ist  and  2nd  intercostal  arteries  come  from  the  sub- 
clavian  trunk,  vide  p.  64). 

ABDOMINAL   AORTA. 

Extent. — From  last  dorsal  vertebra  to  the  left  side  of  body 
of  4th  lumbar  vertebra,  there  dividing  into  common  iliacs. 

Course  and  Relations. — Enters  abdomen  between  pillars  of 
diaphragm,  occupying  middle  line  of  spine,  but  near  its  bifur- 
cations inclines  to  left  side. 

In  front,  from  above  down.  Small  omentum,  stomach,  solar 
plexus,  pancreas,  splenic  vein,  left  renal  vein,  3rd  part  of 
duodenum,  root  of  mesentery,  coils  of  small  intestine,  aortic 
plexus  and  peritoneum.  It  touches  the  pancreas  and  duodenum 
without  any  intervening  peritoneum. 

Behind.  Bodies  of  upper  4  lumbar  vertebrae,  left  lumbar 
veins,  receptaculum  chyli  and  thoracic  duct.  Embraced  by 
crura  of  diaphragm  above. 

On  right  side.  Vena  cava  inferior,  thoracic  duct,  vena  azygos 
major,  and  right  semilunar  ganglion. 

On  left  side.  Left  sernilunar  ganglion,  and  left  cord  of 
sympathetic. 

Branches : — 

Inferior  phrenic  (2):  arising  close  together  immediately 
below  diaphragm,  pass  on  its  under  surface  across  crura,  the 
left  one  passing  behind  oesophagus,  the  right  one  behind 
inferior  vena  cava. 

Branches : — 

Internal :  to  fore-part  of  diaphragm  ;  anas,  fellow,  and 
superior  and  musculo-phrenic  of  internal  mammary. 

External :  to  outer  side  of  muscle ;  anas,  musculo-phrenic, 
lower  intercostals. 

Superior  capsular :  to  supra-renal  body. 

Cceliac  axis  :  arises  between  pillars  of  diaphragm,  just 
above  pancreas,  £  incn  I°ng5  surrounded  by  solar  plexus ; 
divides  into  three  visceral  branches. 

Branches : — 

CORONARY  OF  STOMACH  :  smallest  of  three  branches,  directed 
upwards  and  to  left  side  behind  lesser  sac  of  peritoneum  to  car- 
diac end  of  stomach  ;  gives  off  a  few  cesophageal  branches,  then 
turns  to  right  along  lesser  curvature,  giving  branches  on  each 
side  to  viscus,  finally  anastomoses  with  pyloric  of  hepatic. 

HEPATIC  :  directed  (to  right)  forwards  and  upwards  between, 
layers  of  small  omentum,  and  anterior  to  foramen  of  Winslow,. 


ARTERIES  83 

to  transverse  fissure  of  liver,  lying  to  left  of  common  bile-duct 
and  in  front  of  vena  portae ;  at  transverse  fissure  it  divides  into 
right  and  left  hepatic,  supplying  corresponding  lobes  of  the 
liver. 

Branches : — 

Pyloric :  extends  on  leser  curvature  of  stomach  running 
from  right  to  left ;  anas,  coronary. 

G astro- duodenal :  passes  behind  ist  part  of  dubdenum, 
divides  at  lower  border  into  the  two  following  branches : 

Right  gastro-epiploic  :  runs  along  great  curvature  of  stomach 
from  right  to  left,  anas,  with  left  gastro-epiploic  of  splenic, 
gives  off  branches  upwards  to  viscus  and  downwards  to 
'omen  turn. 

Superior  Pancreatico-duodenal :  runs  between  the  2nd  part  of 
duodenum  and  the  pancreas  down  to  anas,  with  inferior 
pancreatico-duodenal  of  superior  mesenteric. 

Right  Hepatic,  to  right  lobe  of  liver,  giving  off  Cystic:  to 
supply  gall-bladder. 

Left  Hepatic,  to  left  lobe,  giving  off  branch  to  Spigelian  lobe. 

SPLENIC  :  directed  horizontally  to  left  along  upper  border  of 
pancreas,  crossing  the  left  kidney ;  reaches  spleen  by  passing 
between  two  layers  of  lieno-renal  ligament,  and  then  gastric 
branches  reach  stomach  between  layers  of  gastro  -  splenic 
omentum  :  supplies  spleen  and  partly  stomach  and  pancreas. 
Very  tortuous;  divides  near  spleen  into  several  terminal 
branches  which  enter  hilum  of  that  viscus. 

Branches : — 

Pancreatic :  given  off  as  artery  runs  along  pancreas  ;  one  of 
them  (arteria  pancreatica  magna)  accompanies  the  duct,  running 
from  left  to  right. 

Left  gastro-epiploic :  directed  to  right  side  between  layers  of 
great  omentum,  along  great  curvature  of  stomach.  Anas- 
tomoses with  right  gastro-epiploic  of  hepatic. 

Gastric  branches  (vasa  brevia]  (5  or  6)  :  extend  to  left  ex- 
tremity of  stomach  to  supply  its  coats. 

Supra-renal  or  middle  capsular  (2)  arises  a  little  below 
coeliac  axis ;  each  runs  transversely  outwards  over  crus  of 
diaphragm  to  supra-renal  body ;  anas,  superior  capsular  of 
phrenic  and  inferior  capsular  of  renal. 

Superior  mesenteric :  arises  £  inch  below  coeliac  axis,  passes 
forwards  between  pancreas  and  upper  border  of  3rd  part 
of  duodenum,  crosses  duodenum,  and  directed  downwards 
and  to  the  right  between  the  layers  of  the  mesentery,  termi- 
nates in  offsets  to  small  intestine,  caecum  and  colon. 

Relations. — In  front  and  above.    Pancreas  and  splenic  vein. 

6-a 


84  THE  POCKET  ANATOMY 

Behind.  Duodenum,  3rd  part,  and  left  renal  vein.  Sur- 
rounded by  mesenteric  plexus  of  nerves  and  accompanied  by 
its  vein,  which  lies  anterior  and  to  right. 

Branches : — 

Inferior  Pancreatico- duodenal :  directed  from  left  to  right 
along  concave  border  of  3rd  part  of  duodenum  ;  anas,  superior 
pancreatico-duodenal. 

Vasa  intestini  tennis :  to  supply  jejunum  and  ileum,  twelve 
or  fifteen  in  number ;  spring  from  left  convex  side  of  artery  ; 
about  2  inches  from  origin  they  bifurcate,  each  division 
uniting  with  a  neighbouring  branch  to  form  an  arch, 
from  which  branches  issue ;  these  divide  and  communicate 
in  the  same  way  four  or  five  times,  the  resultant  branches 
proceeding  directly  to  intestine. 

Ileo-colic:  from  right  side  of  artery  down  to  caecum,  branch- 
ing to  supply  head  of  colon.  A  descending  branch  to  lower 
part  of  ileum.  An  ascending  to  ascending  colon  and  anas. 
with  right  colic. 

Right  colic  (often  a  branch  of  ileo-colic) :  from  right  side  of 
trunk  to  middle  of  ascending  colon,  ascending  branch  anas. 
middle  colic,  descending  branch  anas,  ileo-colic. 

Middle  colic :  passing  forward  in  transverse  meso-colon  from 
upper  part  of  right  side  of  artery,  supplies  transverse  colon  ; 
right  branch  anas,  right  colic  ;  left  branch  anas,  on  descending 
colon,  with  left  colic  of  inferior  mesenteric. 

Renal  (2)  :  one  from  each  side  arising  £  inch  below  superior 
mesenteric,  the  right  a  little  lower  than  the  left  one.  Pass 
outwards  to  supply  kidneys,  the  right  one  passing  behind 
vena  cava.  Each  divides  near  viscus  into  four  or  five 
branches,  which  enter  it  between  vein  and  ureter.  Is  ac- 
companied by  plexus  of  nerves,  supplies  branches  to  supra- 
renal body  (inferior  capsular],  ureter  and  fat  around. 

Spermatic  :  two  small  but  very  long  arteries ;  arise  just 
below  renal,  directed  downwards  and  outwards  behind  peri- 
toneum over  psoas,  crossing  ureter  and  external  iliac  artery 
(the  right  one  crosses  also  the  inferior  vena  cava)  to  internal 
abdominal  ring,  thence  accompanied  by  spermatic  vein, 
spermatic  plexus,  and  vas  deferens,  it  passes  along  inguinal 
canal,  and  out  of  the  external  ring  to  the  scrotum,  where  it 
divides  into  branches  which  enter  the  posterior  surface  of 
the  testis  ;  anas,  artery  of  vas  deferens  and  cremasteric. 

In  the  female  the  artery  is  termed  ovarian,  and  runs 
between  layers  of  broad  ligament  of  uterus,  to  ovary  and 
round  ligament. 

Inferior  mesenteric :  arises  on  left  side  of  aorta,  about 


ARTERIES  85 

i£  inches  above  bifurcation.  Lies  at  first  on  left  side 
of  aorta,  then  crosses  over  left  psoas,  left  common  iliac  and 
ureter,  to  back  of  rectum  ;  supplies  descending,  iliac  and 
pelvic  parts  of  colon  and  rectum. 

Branches : — 

Left  colic :  directed  upwards  in  front  of  left  kidney,  ascending 
branch  anas,  middle  colic;  descending  branch  supplies  descend- 
ing colon  ;  anas,  sigmoid  and  superior  haemorrhoidal. 

Sigmoid :  to  iliac  and  pelvic  colon ;  anas,  left  colic  and 
superior  haemorrhoidal. 

Superior  h&morrhoidal :  continuation  of  inferior  mesenteric 
trunk,  passes  behind  rectum  and  divides  in  meso-rectum  into 
two  branches,  which  pass  down,  one  on  either  side,  to  about 
6  inches  from  anus,  where  they  subdivide  to  supply  pelvic 
colon  and  rectum ;  anas,  sigmoid,  middle  and  inferior 
haemorrhoidals. 

Lumbar  (5  pairs]  :  arise  from  back  of  aorta,  pass  outwards, 
resting  on  body  of  corresponding  vertebrA  underneath  sym- 
pathetic and  psoas  ;  the  two  upper  pairs  under  crura  of 
diaphragm ;  the  right  ones  also  under  vena  cava.  Divide 
near  transverse  processes  into  : — 

Abdominal :  coursing  outwards  beneath  quadratus  (the  first 
pair  cross  quadratus),  to  end  between  muscles  of  abdominal 
wall ;  anas,  deep  epigastric,  internal  mammary,  intercostals, 
ilio-lumbar,  circumflex  iliac. 

Dorsal :  accompanies  posterior  primary  branch  of  nerve, 
gives  off  spinal  branch  to  supply  meninges  and  cord  ;  anas. 
intercostal. 

Middle  sacral :  a  small  branch  given  off  just  at  bifurcation 
courses  over  5th  lumbar  vertebra  and  middle  of  sacrum  to 
coccyx  behind  the  left  common  iliac  vein,  anas,  lateral  sacral. 

THE    COMMON    ILIAC    ARTERY. 

Extent. — From  bifurcation  of  aorta,  on  body  of  4th  lumbar 
vertebra,  to  opposite  lumbo-sacral  articulation,  there  dividing 
into  external  and  internal  iliac.  About  2  inches  long. 

Relations. — In  front.  Peritoneum,  small  intestines,  ureter, 
branches  of  sympathetic. 

Differences  between  right  and  left  artery. — The  right  one  is  the 
longer,  the  aorta  being  on  the  left  side  of  spine ;  on  right 
side  are  inferior  vena  cava  and  right  psoas.  Companion  vein 
at  first  behind,  but  to  the  right  at  upper  part ;  left  common 
iliac  vein  behind.  The  left  one  is  crossed  anteriorly  by 
inferior  mesenteric  artery,  the  companion  vein  being  below 
and  internal. 


86  THE  POCKET  ANATOMY 

Collateral  branches. — None  named,  supplies  peritoneum, 
psoas,  ureters,  and  lymphatics.  One  of  the  renal,  lumbar  or 
ilio-lumbar  vessels  may  come  off  from  it. 

THE   INTERNAL    ILIAC   ARTERY. 

Extent. — From  bifurcation  of  common  iliac  opposite  lumbo- 
sacral  articulation  to  great  sacro-sciatic  notch,  there  dividing 
into  anterior  and  posterior  trunks.  i£  inches  long. 

Relations  :  in  front  peritoneum,  crossed  by  ureter,  ileum  on 
right,  pelvic  colon  on  left :  behind  on  inner  border  of  psoas, 
internal  iliac  vein,  lumbo-sacral  cord  and  sacrum.  Note  that 
this  artery  lies  inside  parietal  layer  of  pelvic  fascia,  which  is 
pierced  by  all  the  parietal  branches,  e.g.,  sciatic,  gluteal. 

From  the  extremity  a  partly  obliterated  artery,  the  hypo- 
gastric,  extends  forwards  to  "side  of  bladder,  between  the 
layers  of  posterior^false  ligament.  In  the  foetus  this  vessel  is 
nearly  as  large  as  the  common  iliac,  ascends  the  wall  of 
abdomen  to  umbilicus,  passing  thence  to  placenta ;  after 
birth  the  vessel  becomes  obliterated  except  i^  inches  at  com- 
mencement. 

Branches  from  Anterior  Trunk  : 

Superior  vesical :  is  the  unobliterated  part  of  hypogastric, 
extending  from  sacro-sciatic  notch  in  posterior  false  ligament 
to  side  of  bladder. 

Branches  supplied  to  side  and  upper  part  of  bladder,  and  to 
ureter. 

Artery  of  vas  defer  ens  :  accompanies  duct  to  anas,  with  sper- 
matic. 

Middle  vesical :  supplies  side  of  bladder. 

Inferior  vesical :  supplies  base  of  bladder,  side  of  prostate 
and  vesiculae  seminales  in  the  male. 

Middle  hsemorrhoidal :  supplies  lower  part  of  rectum  and  in 
the  female  to  vagina.  May  come  off  from  inferior  vesical ; 
anas,  superior  haemorrhoidal  of  inferior  mesenteric,  inferior 
haemorrhoidal  of  internal  pudic. 

[Uterine :  down  to  neck  of  uterus,  passes  inwards  between 
layers  of  broad  ligament  to  supply  body  of  viscus,  where  it 
crosses  the  ureter  superiorly  and  then  divides  into  a  large 
ascending  branch  to  fundus  and  ovary,  anas,  ovarian  ;  and 
small  descending  branch  to  vagina,  anas,  vaginal. 

Vaginal :  corresponds  to  inferior  vesical  in  male,  supplies 
vagina,  fundus  of  bladder,  and  lower  part  of  rectum.] 

Obturator :  directed  to  groove  in  upper  part  of  thyroid 
foramen,  passing  out  of  pelvis  and  dividing  into  two  branches 


ARTERIES  87 

at  upper  border  of  obturator  externus.  In  pelvis  it  is  placed 
between  pelvic  fascia  and  peritoneum,  and  just  below  obtu- 
rator nerve.  It  lies  beneath  the  horizontal  pubic  ramus  with 
companion  vein  and  nerve  in  canal,  formed  above  by  bone 
and  below  by  obturator  membrane. 

Branches  within  pelvis  : — 

Iliac :  enters  iliac  fossa,  supplies  iliacus  and  bone  ;  anas. 
ilio-lumbar. 

Pubic :  ascends  posterior  surface  of  pubis ;  anas,  opposite 
fellow,  deep  epigastric. 

Branches  outside  pelvis  : — 

Internal  terminal :  curves  inwards  beneath  obturator  ex- 
ternus, supplies  obturators,  gracilis,  and  adductors;  anas. 
internal  circumflex,  and  external  branch  of  obturator. 

External  terminal :  passes  downwards  and  outwards  beneath 
obturator  externus  to  ischial  tuberosity,  supplies  obturators, 
hamstrings  and  hip-joint  ;  anas,  sciatic  and  internal  branch 
of  obturator. 

Internal  Pudic : — 

In  the  male.  Proceeds  out  of  pelvis  by  great  sacro-sciatic 
notch  below  pyriformis,  winds  round  ischial  spine,  re-enters 
pelvis  by  small  notch,  passes  within  the  obturator  fascia  on 
inner  side  of  tuber  ischii,  courses  along  pubic  arch,  perforates 
the  two  layers  of  triangular  ligament  very  obliquely,  dividing 
on  triangular  ligament  into  dorsal  of  penis  and  artery  of 
corpus  cavernosum. 

Relations. — In  the  pelvis,  lies  to  outer  side  of  rectum,  in 
front  of  pyriformis  and  sacral  plexus.  In  gluteal  region  is 
seen  under  gluteus  maximus,  on  ischial  spine,  below  pyri- 
formis, external  to  pudic  nerve,  and  internal  to  nerve  to 
obturator  internus.  Thence,  in  company  with  vein  and  nerve, 
it  is  on  external  wall  of  ischio-rectal  fossa,  and  internal  to 
obturator  internus.  Beneath  triangular  ligament  crossed  by 
transverse  perineal  muscle. 

Branches : — 

Inferior  hamorrhoidal :  arises  just  inside  tuber  ischii,  piercing 
Alcock's  canal,  crosses  transversely  ischio-rectal  fossa,  sup- 
plies sphincter  and  levator  ani ;  anas,  middle  hsemorrh'oidal 
and  opposite  fellow. 

Superficial  perineal :  arising  half-way  in  ischio-rectal  fossa, 
runs  parallel  to  pubic  arch,  crossing  transversus  perinei,  lying 
deep  to  Colics'  fascia,  between  erector  penis  and  accelerator 
urinae,  supplying  them,  together  with  scrotum  ;  anas,  super- 
ficial pudic  of  femoral. 

Transverse  pciincal :  arises  from  superficial  perineal  or  from 


88  THE  POCKET  ANATOMY 

trunk  near  it,  courses  transversely  inwards,  supplying  integu- 
ments, etc. 

Artery  of  bulb  :  arises  near  base  of  triangular  ligament,  as 
internal  pudic  artery  lies  between  the  two  layers  of  triangular 
fascia,  it  then  pierces  anterior  layer,  reaching  bulb  ^  inch 
from  base.  Supplies  a  branch  to  Cowper's  gland. 

Artery  of  corpus  cavernosum :  lies  between  crus  penis  and 
pubic  ramus.  Enters  crus  and  is  distributed  to  corpus  caver- 
nosum. 

Dorsal  artery  of  penis  :  lies  between  crus  and  pubic  ramus, 
through  suspensory  ligament,  along  dorsum  of  penis  having 
the  median  dorsal  vein  inside  and  the  nerve  outside.  It  ends 
in  the  glans  and  prepuce. 

In  the  female :  the  vessel  is  smaller  and  has  similar  course 
to  that  in  male ;  the  superficial  perineal  supplies  labia  pudendi 
The  artery  of  bulb  supplies  bulbus  vestibuli.  The  terminal 
dorsal  and  corpus  cavernosum  arteries  supply  clitoris,  being 
named  dorsalis  and  profunda  clitoridis  respectively. 

Sciatic  :  terminal  branch  of  anterior  trunk  (vide  Arteries  of 
Lower  Limb,  p.  89). 

Branches  from  Posterior  Trunk  : — 

Gluteal :  vide  Arteries  of  Lower  Limb  (p.  90). 

Ilio-lumbar :  passes  upwards,  backwards,  and  outwards 
beneath  psoas  and  obturator  nerve,  but  anterior  to  lumbo- 
sacral  cord ;  divides  in  iliac  fossa  into  ascending  or  lumbar 
branch,  supplying  psoas,  quadratus  lumborum,  and  giving  a 
spinal  branch  through  foramen  between  5th  lumbar  vertebra 
and  the  sacrum.  Transverse  or  iliac  ramifies  in  iliacus,  sup- 
plies bone ;  anas,  lumbar,  deep  circumflex  iliac. 

Lateral  sacral  (2)  :  Superior,  the  larger  of  the  two  dis- 
tributed to  upper  part  of  sacrum,  the  Inferior  to  lower  part  of 
sacrum  and  coccyx ;  anas,  middle  sacral  and  opposite  artery. 

Branches  (dorsal)  are  given  off,  which  enter  anterior  sacral 
foramina  for  distribution  on  back  of  sacrum. 

THE   EXTERNAL   ILIAC   ARTERY. 

Extent. — From  bifurcation  of  common  iliac  opposite  lumbo- 
sacral  articulation  to  lower  border  of  Poupart's  ligament. 

Course. — Lower  §  of  line  from  f  inch  below  and  little  to  left 
of  umbilicus,  to  point  of  Poupart's  ligament  midway  between 
symphysis  pubis  and  anterior  superior  iliac  spine. 

Relations.— Covered  by  peritoneum  and  sub-peritoneal  fat, 
crossed  by  ureter  and  deep  circumflex  iliac  vein,  on  the 
right  by  ileum,  left  by  iliac  colon.  The  spermatic  vessels 
and  genito-crural  nerve  lie  on  it  for  a  short  distance. 


ARTERIES  89 

To  outer  side,  psoas,  except  at  termination,  when  it  is 
behind.  Inner  side,  vas  deferens  and  lymphatic  glands.  The 
left  vein  is  internal  to  its  artery.  The  right  one  is  at  first 
internal,  but  at  upper  part  beneath  its  artery. 

Branches : — 

Deep  epigastric :  from  fore  part  of  artery,  just  above 
Poupart's  ligament,  down  to  ligament,  then  upwards  and 
inwards  between  peritoneum  and  fascia  transversalis,  being 
crossed  externally  by  vas  deferens  near  internal  abdominal 
ring;  pierces  transversalis  fascia,  and  then  passes  upwards 
behind  rectus  to  enter  sheath  under  semilunar  fold  of  Douglas ; 
terminates  between  rectus  abdominis  and  sheath  in  anas- 
tomoses with  superior  epigastric  branch  of  internal  mammary 
and  lower  intercostals. 

Branches : 

Cremasteric :  accompanies  vas  deferens,  supplying  cremaster ; 
anas,  spermatic,  artery  of  vas  deferens. 

Pubic :  ramifies  behind  pubis  ;  anas,  pubic  of  obturator. 

Muscular :  to  rectus  ;  anas,  superficial  epigastric. 

Deep  circumflex  iliac:  from  outer  side  of  artery,  near 
Poupart's  ligament,  directed  to  anterior  superior  iliac  spine, 
then  on  iliac  crest,  gradually  piercing  transversalis  fascia  and 
muscle  and  supplying  iliacus,  etc.  ;  anas,  ilio-lumbar. 


ARTERIES  OF  LOWER  LIMB. 

THE    SCIATIC   ARTERY. 

Largest  branch  of  internal  iliac,  except  gluteal,  passes  out 
through  lower  part  of  great  sacro-sciatic  foramen,  between 
pyriformis  and  superior  gemellus,  in  company  with  great 
sciatic  nerve  and  internal  pudic  artery,  outside  the  pelvis  it 
lies  between  the  tuber  ischii  and  great  trochanter,  under 
gluteus  maximus,  below  which  it  ends  in  cutaneous  branches 
to  thigh. 

Branches  : — 

Within  the  pelvis.  Muscular  to  pyriformis,  coccygeus  and 
levator  ani. 

Outside  pelvis : — 

Coccygeal  branch :  pierces  great  sacro-sciatic  ligament,  in- 
clined inwards,  supplies  gluteus  maximus,  integument,  etc. 

Comes  nervi  ischiadici :  accompanies  great  sciatic  nerve, 
finally  enters  the  substance  of  it. 

Muscular :  branches  to  gluteus  maximus  and  external 
rotators  of  thigh  ;  anas,  gluteal,  internal^  circumflex. 


go  THE  POCKET  ANATOMY 

Anastomotic  :  (i)  to  pit  of  great  trochanter  (digital  anas- 
tomosis], supplies  external  rotators ;  anas,  gluteal,  ascending 
of  internal  circumflex,  and  (2)  to  crucial  anastomosis;  anas. 
first  perforating,  internal  and  external  circumflex. 

Articular :  to  capsule  of  hip-joint. 

THE   GLUTEAL   ARTERY. 

Largest  branch  of  internal  iliac,  passes  outwards  between 
lumbo-sacral  cord  and  ist  sacral  nerve,  escapes  from  pelvis 
above  pyriformis,  divides  immediately  into  superficial  and 
deep  branches. 

Superficial  branch :  runs  between  the  two  larger  glutei,  sup- 
plying gluteus  maximus  ;  anas,  sciatic  and  internal  circumflex. 

Deep  branch :  goes  between  two  smaller  glutei,  subdivides 
into  two : — 

Superior  division  :  goes  to  anterior  superior  iliac  spine  ;  anas. 
circumflex  iliacs,  ascending  branches  of  external  circumflex. 

Inferior  division :  supplies  gluteal  muscles,  and  descends  to 
great  trochanter  ;  anas,  external  circumflex. 

Nutrient  branch  :  enters  hip-bone  just  as  artery  emerges 
from  pelvis. 

THE    FEMORAL    ARTERY. 

Extent. — From  Poupart's  ligament  to  the  opening  in  the 
adductor  magnus. 

Course. — Thigh  being  abducted  and  rotated  out,  a  line 
drawn  from  point  midway  between  symphysis  pubis  and 
anterior  superior  iliac  spine  to  most  prominent  part  of  in- 
ternal condyle  of  femur,  will  in  upper  §rd  give  course. 

Relations. — Superficial  in  upper  £rd,  being  contained  in 
Scarpa's  triangle, -more  deeply  placed  in  middle  Jrd  (Hunter's 
canal).  In  first  i^  inches  is  enclosed  in  femoral  sheath. 

In  front.  Skin,  superficial  and  deep  fascia,  internal  cutane- 
ous branch  of  anterior  crural  nerve,  sartorius,  long  saphen- 
ous  nerve,  aponeurotic  arch  over  Hunter's  canal. 

Behind.  Psoas,  prcfunda  vessels,  pectineus,  adductor  longus, 
femoral  vein  (at  lower  part  of  Scarpa's  triangle,  and  in 
Hunter's  canal),  tendon  of  adductor  magnus. 

Inner  side.  Femoral  vein  (in  Scarpa's  space),  adductor 
longus. 

Outer  side.  Sartorius  (in  Scarpa's  space),  vastus  internus, 
femoral  vein  gets  to  outer  side  near  ending. 

Branches : — 

Superficial  epigastric :  arises  $  inch  below  Poupart's  liga- 
ment, ascends  through  the  saphenous  opening  to  abdominal 


ARTERIES  91 

wall,  as  high  as  umbilicus,  in  the  fascia,  anas,  fellow  of 
opposite  side,  superficial  branches  of  deep  epigastric. 

Superficial  circnmflex  iliac :  arises  near  preceding,  runs 
outwards  to  iliac  crest,  supplies  glands,  fasciae,  and  integu- 
ment, psoas  and  iliacus;  anas,  deep  circumflex  iliac,  gluteal, 
external  circumflex. 

Superior  external  pudic :  arises  from  inner  side  of  artery 
^  inch  below  Poupart's  ligament,  pierces  cribriform  fascia  of 
saphenous  opening,  runs  upwards  to  pubic  spine,  crosses  ex- 
ternal ring  and  spermatic  cord,  supplying  integument  of  lower 
part  of  abdomen  and  external  organs  of  generation  ;  anas,  in- 
ternal pudic. 

Deep  external  pudic :  arises  either  separately  or  from  a 
common  trunk  with  the  preceding,  lies  on  pectineus,  covered 
by  fascia  lata,  which  it  pierces,  and  is  distributed  to  scrotum 
in  male  and  labium  in  female ;  anas,  superficial  perineal. 

Profunda  femoris :  arises  from  outer  and  back  part  of  artery, 
i  or  2  inches  below  Poupart's  ligament,  and  passing  outwards 
and  downwards  rests  in  Scarpa's  triangle  upon  the  iliacus, 
then  curving  inwards,  crosses  psoas  and  pectineus  behind  the 
femoral  artery,  from  which  it  is  separated  by  the  deep  femoral 
vein ,  and  lies  subsequently  upon  adductores  brevis  and  magnus, 
having  the  longus  superficial  to  it.  It  ends  in  the  lower  third 
of  thigh  in  a  branch  which  perforates  adductor  magnus. 

Brandies : — 

External  circumflex :  arises  from  the  outer  side  of  the  pro- 
funda  (sometimes  from  the  femoral  trunk),  coursing  under 
rectus  and  sartorius  outwards  through  the  divisions  of  the 
anterior  crural  nerve,  dividing  into  : 

(a)  Transverse  branches,  piercing  vastus  externus  just  below 
great  trochanter;  anas,  below  trochanter  with  internal  circum- 
flex, first  perforating  branch  of  profunda,  and  sciatic,  (crucial 
anastomosis). 

(b)  Ascending  pass  beneath  sartorius,  rectus,  and   tensor 
fasciae  femoris ;    anas,   with   terminal    of  gluteal   and   deep 
circumflex  iliac. 

(c)  Descending  branches  are  distributed  to  the  extensors  of 
the  thigh ;  anas,  with  superior  articular  arteries,  a  small  offset 
passing,  with  the  articular  nerve  from  the  nerve  to  vastus  ex- 
ternus, to  the  knee-joint. 

Internal  circumflex :  arises  from  the  internal  and  back  part 
of  profunda,  courses  backwards  between  psoas  and  pectineus, 
and  then  below  capsule  of  hip  between  obturator  externus 
and  adductor  brevis,  dividing  at  the  small  trochanter  into 
two  branches,  one  ascending  deep  to  quadratus  femoris  to 


92  THE  POCKET  ANATOMY 

the  digital  fossa  of  the  great  trochanter  ;  anas,  sciatic  and 
gluteal ;  the  other  passes  to  the  hamstrings,  appears  between 
adjacent  borders  of  quadratus  femoris  and  adductor  magnus, 
gives  off  muscular  branch  at  upper  border  of  adductor  brevis, 
which  divides  into  superficial  and  deep  branches  to  upper 
adductor  muscles,  the  trunk  of  the  artery  then  passes  out- 
wards and  backwards  ;  anas,  first  perforating,  sciatic,  and 
external  circumflex  (crucial  anastomosis}.  An  articular  branch 
enters  the  joint  through  the  notch  in  acetabulum. 

Perforating  branches :  four  in  number,  reach  the  back  of 
thigh  by  perforating  the  adductor  magnus,  and  end  in  the 
back  of  thigh : — 

First,  begins  opposite  lower  border  of  pectineus,  perforates 
adductores  brevis  and  magnus,  distributed  to  biceps  and 
gluteus  maximus ;  anas,  sciatic,  internal  and  external 
circumflex. 

Second,  comes  off  opposite  middle  of  short  adductor,  per- 
forating it  and  the  magnus,  distributed  to  hamstrings ;  a 
nutrient  artery  (passing  upwards)  is  given  off;  anas,  other 
perforating  branches. 

Third,  arises  at  the  lower  border  of  adductor  brevis,  per- 
forates magnus,  as  the  second,  ending  in  the  biceps. 

Fourth,  or  terminal  branch,  pierces  adductor  magnus  near 
opening  for  femoral  vessels,  supplies  short  head  of  biceps ; 
anas,  popliteal  and  lower  perforating. 

Muscular  Branches  :  two  to  seven  in  number,  supplying 
sartorius  and  vastus  internus. 

Anastomotic  branch :  arises  at  the  termination  of  the  femoral, 
and  courses  in  the  line  of  the  femoral  to  the  internal  condyle. 

Branches  :— 

Deep  branch,  descends  inner  side  of  knee ;  anas,  superior 
internal  articular  ;  gives  off  external  branch,  crosses  the  femur, 
supplying  branches  to  knee-joint ;  anas,  superior  external 
articular,  forming  an  arch  above  patella. 

Superficial  branch,  accompanies  long  saphenous  nerve  to 
integument;  anas,  inferior  internal  articular. 

THE    POPLITEAL   ARTERY. 

Extent.  —  From  the  opening  in  the  adductor  magnus  to 
lower  border  of  popliteus,  dividing  into  anterior  and  posterior 
tibial. 

Course. — Upper  part  inclines  from  inner  side  of  femur  to 
middle  of  intercondylar  space,  thence  occupying  middle  line 
of  popliteal  space. 


ARTERIES  9, 

Relations.— The  part  of  artery  in  the  popliteal  space  is 
partly  covered  by  the  semimembranosus,  and  below  it  is 
covered  by  the  gastrocnemius  and  plantaris.  It  rests  upon 
the  femur,  posterior  ligament  of  knee-joint  and  popliteus. 
The  vein  lies  to  the  outer  side  in  the  upper  part,  but  crosses 
to  the  inner  side  near  the  termination.  Superficial  and  slightly 
external  to  the  artery  is  the  internal  popliteal  nerve,  in  the 
upper  part,  but  below  it  crosses  to  inner  side.  A  small 
articular  branch  of  the  obturator  nerve  courses  upon  the  artery. 

Branches : — 

Muscular  :  Superior  set  (3  or  4) :  to  lower  end  of  hamstrings ; 
anas,  perforating  of  profunda,  superior  articular. 

Inferior  set  or  sural  (2) :  arise  from  the  posterior  part  of 
artery  opposite  knee-joint,  supply  both  heads  of  gastroc- 
nemius, plantaris  and  soleus. 

Superficial :  accompanies  external  saphenous  nerve  to  end 
in  integuments. 

Superior  articular :  Internal.  Arises  just  above  condyles  of 
femur,  courses  transversely  inwards  beneath  semimembranosus 
and  tendon  of  adductor  magnus  to  front  of  knee,  ending  in 
vastus  intern  us  and  joint ;  anas,  anastomotic  and  superior 
external  articular. 

External.  Winds  beneath  biceps,  perforates  intermuscular 
septum ;  anas,  descending  branch  of  external  circumflex,  ex- 
ternal of  anastomotic  and  superior  internal  articular,  forming 
an  arch,  inferior  external  articular;  supplies  joint  by  super- 
ficial and  deep  branches. 

Inferior  articular:  Internal.  Passes  down  on  internal 
tuberosity  of  tibia,  beneath  inner  head  of  gastrocnemius  and 
internal  lateral  ligament ;  anas,  opposite  artery,  superior  in- 
ternal articular,  anterior  tibial  recurrent. 

External.  Courses  outwards  under  outer  head  of  gastroc- 
nemius, plantaris  and  external  lateral  ligament ;  anas,  in  front 
with  other  articular  branches,  anterior  tibial  recurrent. 

Azygos  articular :  arises  opposite  flexure  of  joint,  pierces 
posterior  ligament,  supplying  crucial  ligaments  and  other 
structures  in  the  joint. 

THE   ANTERIOR   TIBIAL   ARTERY. 

Extent. — From  division  of  popliteal  artery  at  lower  border 
of  popliteus,  to  bend  of  ankle,  where  it  becomes  dorsalis 
pedis. 

Course. — At  first  directed  outwards  and  forwards,  through 
two  heads  of  origin  of  tibialis  posticus,  to  reach  anterior  sur- 
face of  interosseous  membrane;  thence  a  line  drawn  from 


94  THE  POCKET  ANATOMY 

inner  side  of  head  of  fibula  to  midway  between  the  two 
malleoli  will  mark  its  course. 

Relations. — Tibialis  anticus  to  inner  side,  the  extensor  com- 
munis  digitorum  above,  and  the  extensor  proprius  hallucis 
below  upon  its  outer  side,  covered  below  by  annular  ligament 
and  crossed  by  extensor  proprius  hallucis  tendon,  rests  below 
upon  the  anterior  surface  of  the  tibia.  It  is  accompanied  by 
two  venae  comites.  Anterior  tibial  nerve  lies  at  first  on  outer 
side,  then  becomes  superficial,  and  below  is  on  the  outer  side. 

Branches : — 

Posterior  Tibial  Recurrent :  passes  upwards  deep  to  popli- 
teus  to  back  of  knee. 

Superior  Fibular:  passes  over  neck  of  fibula,  through  soleus, 
to  peroneus  longus. 

Anterior  Tibial  Recurrent :  arises  as  artery  reaches  anterior 
surface  of  interosseous  membrane,  passes  in  tibialis  anticus 
to  external  and  anterior  surfaces  of  knee-joint ;  anas,  articular 
of  popliteal. 

Malleolar :  Two  in  number,  arise  just  above  ankle-joint, 
supplying  it. 

Internal.  Passes  beneath  extensor  longus  hallucis  and 
tibialis  anticus  tendons  to  inner  malleolus ;  anas,  branches 
of  posterior  tibial. 

External.  Passes  outwards  beneath  extensor  longus  digi- 
torum and  peroneus  tertius  ;  anas,  anterior  peroneal,  tarsal  of 
dorsalis  pedis. 

Muscular :  to  surrounding  muscles. 

DORSAL  ARTERY  OF  FOOT. 

Extent. — From  bend  of  ankle  to  posterior  part  of  ist  inter- 
osseous  space,  ending  by  anastomosing  with  external  plantar 
artery  to  form  plantar  arch  after  it  has  entered  sole  between 
heads  of  origin  of  ist  dorsal  interosseous  muscle. 

Relations. — Lies  between  tendons  of  extensor  proprius 
hallucis  and  extensor  longus  digitorum  ;  near  termination 
it  is  crossed  by  innermost  tendon  of  extensor  brevis  digitorum. 
Bound  down  by  fascia  lying  on  astragalus,  scaphoid,  and 
middle  cuneiform.  Accompanied  by  two  venae  comites. 
Anterior  tibial  nerve  lies  to  outer  side. 

branches : — 

Tarsal :  arises  as  artery  crosses  scaphoid,  courses  forwards 
and  outwards  beneath  extensor  brevis  digitorum,  supplying 
it,  then  backwards  to  cuboid;  anas,  external  plantar,  meta- 
tarsal,  external  malleolar,  anterior  peroneal. 


ARTERIES  95 

Metatarsal :  arises  near  bases  of  metatarsals,  directed  out- 
wards in  an  arched  direction,  beneath  short  extensor  of  toes 
to  outer  side  of  foot,  near  bases  of  xnetatarsal.  bones ;  anas. 
tarsal,  external  plantar.  From  the  convexity  of  arch  proceed 
three  dorsal  interosseous  branches  to  three  outer  metatarsal 
spaces.  They  supply  the  interossei  and  divide  at  cleft  of 
toes  into  digital  branches ;  the  most  external  one  supplies 
also  outer  side  of  little  toe.  Each  interosseous  artery  com- 
municates at  the  cleft  of  the  toes  with  the  plantar  digitals  by* 
an  anterior  perforating  branch,  and  at  the  back  of  the  inter- 
osseous space  with  the  plantar  arch  by  a  posterior  perforating 
branch. 

The  1st  dorsal  interosseous  artery :  arises  as  dorsalis  pedis 
is  about  to  dip  down  into  sole.  It  lies  over  dorsum  of  ist 
interosseous  space,  and  divides  at  cleft  to  supply  contiguous 
sides  of  ist  and  2nd  toes,  having  previously  given  off  a  branch 
to  inner  side  of  ist  toe. 

Plantar  digital,  or  arteria  magna  hallucis  :  arises  in  sole, 
passes  forwards  in  ist  interosseous  space  to  cleft,  where  it 
divides  into  two  branches  for  contiguous  sides  of  ist  and  2nd 
toes,  having  previously  given  off  a  branch  of  inner  side  of 
great  toe. 

THE    POSTERIOR   TIBIAL    ARTERY. 

Extent. — From  lower  border  of  popliteus  to  lower  edge  of 
internal  annular  ligament  of  ankle,  there  dividing  into  internal 
and  external  plantar,  at  a  spot  midway  between  internal 
malleolus  and  heel. 

Course. — At  first  midway  between  tibia  and  fibula,  after- 
wards approaches  tibia  and  lies  on  it. 

Relations. — Upper  frds  covered  by  gastrocnemius  and 
soleus.  Lower  £rd  superficial  between  inner  border  of  Tendo 
Achillis  and  inner  border  of  tibia.  Posterior  tibial  nerve  is 
at  first  on  inner  side,  but  about  i  inch  down  crosses 
posteriorly  to  reach  outer  side.  Has  vends  comites,  and  lies 
•on  tibialis  posticus,  flexor  longus  digitorum,  tibia,  and  back 
of  ankle-joint. 

Relations  of  artery  at  inner  malleolus,  from  within  outwards. 
Tibialis  posticus  and  flexor  longus  digitorum  tendons,  vein, 
•artery,  vein,  nerve,  flexor  longus  hallucis  tendon. 

Branches : — 

Peroneal :  arises  i  inch  from  popliteus,  courses  obliquely 
to  fibula,  then  along  inner  border  of  that  bone,  between  origins 
•of  tibialis  posticus  and  flexor  longus  hallucis,  to  lower  part  of 
interosseous  membrane,  where  it  gives  off  anterior  peroneal, 


96  THE  POCKET  ANATOMY 

and  is  continued  as  posterior  peroneal  over  lower  tibio-fibular 
articulation  to  outer  side  of  external  malleolus,  where  it  ends 
by  anas,  with  external  plantar  and  tarsal.  Covered  in  upper 
part  by  soleus  and  deep  fascia,  then  by  flexor  longus  hallucis. 
Beyond  the  malleolus  it  is  superficial. 

Branches  of  peroneal  : 

Muscular  ;  to  soleus,  tibialis  posticus,  flexor  longus  hallucis, 
and  peronei. 

Nutrient :  to  the  fibula,  passes  downwards. 

Anterior  peroneal:  arises  about  2  inches  above  external 
malleolus,  pierces  or  passes  below  interosseous  membrane, 
and  under  cover  of  peroneus  tertius  reaches  front  of  outer 
malleolus  and  tarsus,  supplying  ankle-joint ;  anas,  external 
rnalleolar,  tarsal  of  dorsalis  pedis,  and  terminal  of  peroneal. 

Communicating  :  to  join  communicating  of  posterior  tibial. 

Muscular  :  to  soleus,  and  deep  muscles  of  back  of  leg. 

Nutrient :  to  tibia,  arises  near  origin  of  posterior  tibial, 
largest  of  kind  in  body,  passes  downwards. 

Communicating :  arises  2  inches  above  inner  malleolus, 
courses  beneath  flexor  longus  hallucis  ;  anas,  communicating 
of  peroneal. 

Internal  calcaneal :  arises  near  termination,  pierces  internal 
annular  ligament  with  internal  calcaneal  nerve,  to  supply 
integument,  fat  of  heel,  and  muscles  on  inner  side  of  foot. 

INTERNAL   PLANTAR. 

The  smaller  branch  of  the  posterior  tibial,  directed  for- 
wards along  inner  border  of  foot  as  far  as  base  of  ist  meta- 
tarsal  bone,  thence  along  inner  side  of  great  toe  to  anastomose 
with  inner  digital  branch,  is  covered  at  first  by  abductor 
hallucis,  and  subsequently  becomes  more  superficial  by  lying 
between  that  muscle  and  the  flexor  brevis  digitorum ;  it  is 
accompanied  by  internal  plantar  nerve. 

Branches : — 

Digital,  to  clefts  between  four  outer  toes,  joining  digital 
branches  from  plantar  arch. 

Cutaneous,  to  inner  side  and  sole  of  foot. 

Muscular. 

EXTERNAL    PLANTAR. 

From  inner  part  of  foot,  beneath  abductor  hallucis,  it  runs 
with  external  plantar  nerve,  between  flexor  brevis  digitorum 
and  flexor  accessorius,  to  base  of  fifth  metatarsal ;  thence  it 


VEINS  97 

passes  inwards,  resting  on  the  interosseous  muscles  and  deep 
to  flexor  tendons  and  lumbricals  to  the  back  part  of  the  ist 
interosseous  space,  and  anastomoses  with  dorsalis  pedis, 
completing  plantar  arch. 

The  plantar  arch  is  placed  across  the  tarsal  end  of  the  meta- 
tarsus, and  is  accompanied  by  the  deep  branch  of  the  external 
plantar  nerve. 

Branches  from  the  Plantar  Arch  : — 

Recurrent :  small  branches  passing  back  to  tarsal  joints ; 
anas,  branches  of  internal  plantar. 

Posterior  perforating  (3) :  ascend  to  dorsum  of  foot  through 
posterior  part  of  three  outermost  interosseous  spaces ;  anas. 
interosseous  of  metatarsal. 

Digital  (4) :  supply  both  sides  of  three  outer  toes  and  outer 
half  of  2nd ;  inner  three  bifurcate  at  the  cleft  of  toes ;  give 
off  at  point  of  division,  anterior  perforating  to  anas,  with  inter- 
osseous arteries  of  dorsum. 


THE  VEINS. 

VEINS  OF  THE  HEAD  AND  NECK. 

Cerebral :  noted  for  their  thin  coats,  absence  of  muscular 
tissue  and  valves. 

Superior  (10  to  12  on  each  side)  :  lodged  chiefly  in  sulci  on 
cerebral  surface,  pass  forwards  and  inwards  to  superior  longi- 
tudinal sinus. 

Anterior  inferior:  from  under  surface  of  anterior  lobes;  ter- 
minate in  cavernous  sinus. 

Inferior  lateral  (3  to  5) :  terminate  in  lateral  sinus. 

Inferior  median  :  from  posterior  lobe,  etc.,  to  straight  sinus 
behind  venae  Galeni. 

Venae  Galeni  (2,  one  from  right,  one  from  left  lateral  ven- 
tricle) :  formed  by  vena  corporis  striati  and  vena  choroidea ; 
pass  backwards  out  of  transverse  fissure  to  unite  and  end  in 
straight  sinus. 

Cerebellar :  superior,  inferior,  and  lateral  sets ;  the  ist 
open  into  straight,  the  2nd  into  lateral,  the  3rd  into  superior 
petrosal  sinuses. 

Sinuses  (17  in  number):  Superior  longitudinal:  begins  at 
crista  Galli,  where  it  may  communicate  through  foramen 

7 


98  THE  POCKET  ANATOMY 

caecum  with  nasal  veins,  runs  back  in  upper  border  of  falx 
cerebri  to  torcular  Herophili,  usually  joining  right  lateral 
sinus  ;  receives  superior  cerebral,  parietal  and  emissary  veins. 
Intersected  by  fibrous  bands,  the  chordae  Willisii ;  the  lumen 
is  triangular,  and  on  either  side  lie  the  Pacchionian  bodies. 

Inferior  longitudinal :  along  posterior  |  of  free  margin  of  falx 
cerebri  to  straight  sinus. 

Straight :  is  placed  at  junction  of  tentorium  and  falx  cerebri, 
goes  to  torcular  Herophili,  ending  usually  in  left  lateral  sinus  ; 
receives  "inferior  longitudinal  sinus,  vena  magna  Galeni, 
inferior  median  cerebral,  and  superior  cerebellar  veins. 

Lateral  (2) :  from  torcular  Herophili  to  foramen  lacerum  pos- 
terius,  empties  into  internal  jugular  vein,  each  receives  superior 
petrosal  and  occipital  sinuses,  and  mastoid  vein  :  the  right 
also  receives  the  superior  longitudinal  and  the  left  the  straight 
sinus.  Joins  inferior  petrosal  sinus  to  form  internal  jugular 
vein  below  jugular  foramen. 

Occipital  (2) :  smallest ;  from  posterior  margin  of  foramen 
magnum  to  torcular  Herophili. 

Cavernous  (2) :  by  side  of  sella  turcica,  passes  from  sphe- 
noidal  fissure  to  apex  of  petrous  part  of  temporal.  Receives 
ophthalmic  veins  which  connect  the  angular  vein  with  this 
sinus ;  also  anterior  inferior  cerebral  veins  and  sinus  alae 
parvae.  The  ophthalmic  veins  are  two  in  number  :  superior, 
the  larger,  accompanies  artery ;  and  inferior,  running  below 
optic  nerve,  is  formed  by  lower  ciliary  and  muscular  branches, 
and  communicates  with  pterygoid  plexus  ;  both  pass  through 
the  sphenoidal  fissure  to  empty  into  the  cavernous  sinus. 

Circular  :  surrounds  pituitary  body,  connects  the  cavernous 
sinuses. 

Inferior  petrosal  (2) :  from  termination  of  cavernous  to  in- 
ternal jugular  vein,  lies  over  petro-occipital  suture. 

Transverse :  connects  the  inferior  petrosal  sinuses  across 
basilar  process  of  occipital  bone. 

Superior  petrosal  (2) :  placed  on  superior  border  of  petrous 
part  of  temporal,  connecting  lateral  and  cavernous  sinuses ; 
receives  inferior  lateral  cerebral,  and  anterior  lateral  cere- 
bellar veins. 

Sinus  alee  parva  (spheno-parietal)  receives  some  meningeal 
\nd  inferior  cerebral  veins,  and  runs  inwards  along  free 
nargin  of  lesser  wing  of  sphenoid  to  cavernous  sinus. 

Veins  of  the  diploe  :  lodged  in  channels  of  the  bones  of  the 
cranial  vault.  They  are  divided  into  frontal,  joining  the 
supra-orbital  vein  ;  anterior  temporal,  joining  a  deep  temporal 
vein  ;  posterior  temporal,  joining  lateral  sinus ;  and  occipital. 
joining  occipital  vein  or  lateral  sinus. 


VEINS 


99 


Emissary  veins  :  small  veins  passing  through  foramina  in 
the  bones,  and  connecting  the  sinuses  with  the  external  veins 
of  the  head. 

Facial:  passes  obliquely  across  side  of  face  from  inner 
canthus  to  anterior  border  of  masseter,  being  the  continua- 
tion of  the  angular  vein  from  inner  canthus  of  eye.  Under 
the  inferior  maxilla  near  the  angle  it  unites  with  a  branch 
(communicating  facial)  from  temporo-maxillary  vein  to  form 
a  short  trunk  (the  common  facial),  which,  crossing  sub- 
maxillary  gland,  digastric  and  external  carotid  artery,  empties 
into  the  internal  jugular  vein.  Also  communicates  with  oph- 
thalmic (vide  cavernous  sinus). 

f  supra-orbital. 

anSular  Ipalpe^ral  (superior). 

Inasal. 

inferior  palpebral. 
dorsal  and  lateral  nasal. 

alveolar  branches. 


The    facial    vein 
receives  ..     .. 


anterior  internal 
maxillary  (deep- 
facial) 


infra-orbital, 
descending  palatine . 
naso-palatine. 
Vidian. 


superior, 
^inferior, 
buccal. 
masseteric. 
labial, 
submental. 
inferior  palatine. 

glandular  (parotid  and  submaxillary). 
part  of  tamporo-maxillary. 


Temporal :  from  side  and  vertex  of  head,  passes  down  over 
zygoma,  there  receiving  the  middle  temporal  vein ;  it  then 
courses  down  between  condyle  of  jaw  and  external  auditory 
meatus  into  the  substance  of  the  parotid,  where  it  joins  the 
internal  maxillary  vein  to  form  the  temporo-maxillary  trunk. 

"anterior  temporal, 
posterior  temporal. 


The  temporal  vein  receives   4 


middle  temporal. 
parotid, 
anterior  auricular, 
.transverse  facial.  , 

7— a 


ioo  THE  POCKET  ANATOMY 

Internal  maxillary :  is  formed  by  branches  corresponding 
with  those  of  the  internal  maxillary  artery.  The  branches 
form  a  plexus  (pterygoid)  placed  between  the  pterygoid 
muscles.  The  trunk  of  the  vein  passes  backwards  with  artery 
internal  to  neck  of  condyle  to  join  temporal  vein,  and  form 
temporo-maxillary  trunk. 

/•middle  meningeal  (2). 
deep  temporal, 
pterygoid. 
masseteric. 


The  pterygoid  plexus  is 
formed  by 


infra-orbital. 

buccal. 

superior  palatine. 

inferior  dental. 

posterior  dental. 

Vidian. 

The  pterygoid  plexus  communicates  with  the  facial  vein  by 
the  anterior  internal  maxillary  vein  (deep  facial). 

Temporo-maxillary :  formed  by  union  of  temporal  and 
internal  maxillary  veins  ;  descends  in  parotid  gland  on  ex- 
ternal carotid  artery  and  crossed  by  facial  nerve,  divides  into 
two  branches,  one  of  which  unites  with  the  facial  as  the 
communicating  facial,  and  the  other  receives  the  posterior 
auricular  vein  to  form  the  trunk  of  the  external  jugular  vein . 

Posterior  auricular :  from  plexus  on  side  of  head  and  back 
of  ear,  receives  stylo-mastoid  vein,  and  branches  from  ex- 
ternal ear;  joins  into  temporo-maxillary  to  form  external 
jugular  vein. 

Occipital :  from  plexus  at  back  part  of  vertex  of  skull, 
placed  deeply  between  muscles  of  neck,  and  having  on 
scalp  same  course  as  artery;  it  then  passes  deeply  under 
complexus,  over  suboccipital  triangle,  where  it  communicates 
with  vertebral,  and  passes  on  semispinalis  into  deep  cervical 
vein ;  communicates  with  lateral  sinus  by  mastoid  veins. 

External  jugular :  formed  by  junction  of  part  of  temporo- 
maxillary  trunk  and  posterior  auricular  veins  at  angle  of  jaw 
in  the  substance  of  parotid.  Descends  beneath  platysma 
over  sterno-mastoid,  pierces  deep  fascia  near  the  clavicle  to 
open  into  subclavian,  or  occasionally  into  the  internal  jugular. 
Has  two  pair  of  valves.  Receives  posterior  external  jugular, 
draining  superficial  region  at  back  of  neck,  supra-scapular, 
transverse  cervical,  and  frequently  the  anterior  jugular . 

Anterior  jugular :  drains  integument  and  superficial  muscles 
of  anterior,  ^ntf  middje  re^ionso  of  neck.  Empties  into  sub- 
clavian or  dfctfcrn^l  jugular- :  cpmfnunicates  with  *ellow  just 


VEINS  101 

above  the  sternum,  also  with   facial  and  external  jugular 
veins. 

Internal  jugular:  from  jugular  foramen,  being  formed  by 
junction  of  lateral  and  inferior  petrosal  sinuses.  Passes 
vertically  down  the  side  of  neck,  on  the  outer  side  of  carotid 
artery,  within  the  sheath,  uniting  with  subclavian  near  the 
inner  margin  of  the  scalenus  anticus  to  form  the  vena  inno- 
minata.'  Usually  crossed  by  spinal  accessory  and  communi- 
cans  hypoglossi  nerves.  One  pair  of  valves  placed  f  inch 
above  termination. 


'pharyngeal. 

f  dorsal  of  tongue, 
lingual-!  lingual  venae  comites. 

[ranine. 
common  facial. 


The   internal  jugular 
vein  receives  . . 

superior  thyroid* 
middle  thyroid. 

Vertebral :  communicates  with  posterior  spinal  and  occipital 
veins;  drains  occipital  region  and  deep  muscles  of  back  ot 
neck;  enters  foramen  in  transverse  process  of  atlas,  runs 
down  behind  artery  through  same  foramina  of  the  cervical 
vertebrae  to  6th  (or  yth),  where  it  passes  down  to  enter  vena 
innominata.  One  pair  valves  guard  its  mouth. 

(muscular, 
anterior  vertebral, 
deep  cervical, 
ist  intercostal. 

Deep  cervical  (posterior  vertebral)  corresponds  to  profunda 
cervicis  artery ;  lies  deeply  in  neck ;  above  receives  occipital 
and  ends  in  vertebral. 

VEINS  OF  THE  UPPER  EXTREMITY. 

A.    SUPERFICIAL,    LYING   ON    DEEP   FASCIA. 

Anterior  ulnar :  from  the  anterior  and  ulnar  side  of  hand 
up  along  ulnar  side  of  forearm  to  elbow-joint,  to  join  the 
median  basilic. 

Posterior  ulnar :  from  posterior  ulnar  border  of  hand  and 
vein  of  little  finger  (vena  salvatella),  up  along  ulnar  side  of  back 
of  forearm  to  join  median  basilic  just  below  the  elbow-joint. 


102  THE  POCKET  ANATOMY 

Radial :  from  dorsum  of  the  thumb,  radial  side  of  index- 
finger  and  hand,  along  outer  side  of  forearm  to  join  median 
cephalic  near  bend  of  elbow,  and  form  the  cephalic  vein. 

Median :  from  palmar  surface  of  hand  up  the  middle  of 
forearm  communicating  below  the  bend  of  elbow,  with  venae 
comites  of  ulnar,  and  then  divides  into  median  cephalic  and 
median  basilic. 

Median  basilic :  passes  obliquely  inwards  over  bicipital 
fascia,  which  separates  it  from  the  brachial  artery.  Empties 
into  basilic. 

Median  cephalic  :  passes  obliquely  outwards  from  bend  of 
elbow,  between  supinator  longus  and  biceps.  Empties  into 
cephalic. 

Basilic  :  formed  by  coalescence  of  anterior  and  posterior 
ulnar  with  the  median  basilic  veins.  Ascends  on  the  inner 
side  to  middle  of  the  arm,  where  it  pierces  deep  fascia  and 
joins  brachial  venae  comites  to  form  axillary  vein. 

Cephalic  :  passes  up  between  deltoid  and  pectoralis  major, 
perforates  deep  fascia  and  costo-coracoid  membrane,  and 
opens  into  the  axillary  vein.  It  is  occasionally  connected 
with  the  external  jugular  by  a  branch  over  the  clavicle 
(jugulo-cephalic). 

B.  DEEP  VEINS  ACCOMPANYING  THEIR  RESPECTIVE  ARTERIES 
AS  VEN-ffi  COMITES,  INTERCOMMUNICATING  WITH  EACH 
OTHER,  AND  THE  SUPERFICIAL  VEINS  FREQUENTLY. 

Digital  (2)  :  empty  into  the  superficial  palmar. 

Palmar  superficial  (2) :  empty  into  ulnar  and  radial. 

Deep  palmar :  empty  into  radial  venae  comites. 

Interosseous  (2)  :  accompany  the  anterior  and  posterior 
interosseous  arteries,  commencing  at  the  wrist,  terminating 
in  venae  comites  of  the  ulnar. 

Comites  radialis  (2)  :  form,  with  the  ulnar,  the  comites  of 
brachial. 

Comites  ulnaris  (2) :  with  the  radial,  form  comites  of  brachial. 

Comites  brachialis  (2) :  receiving  veins  corresponding  to  the 
branches  of  the  brachial  artery,  empty  into  the  axillary  vein. 

Axillary  (single) :  formed  by  junction  of  brachial  veins 
with  the  basilic.  Commences  at  lower  border  of  the  axillary 
space  ;  receives  veins  corresponding  to  branches  of  its  artery, 
and  terminates  in  the  subclavian  at  outer  border  ist  rib. 
[Valves  at  inferior  border  of  subscapularis,  terminations  of 
subscapular  and  cephalic  veins.] 

Subclavian  :  continuation  of  axillary,  joins  internal  jugular 
vein  behind  the  inner  end  of  the  clavicle  to  form  vena 


VEINS  103 

innominata.  Separated  from  its  artery  by  scalenus  anticus 
muscle  and  phrenic  nerve.  Receives  external  and  anterior 
jugular  veins.  [Valves  just  external  to  entrance  of  external 
jugular,  or  about  i  inch  from  its  termination.] 

VEINS  OF  THE  BODY. 

Innominate  :  two  large  trunks,  placed  one  on  each  side  of 
the  neck,  and  formed  by  the  junction  of  the  internal  jugular 
and  subclavian  veins  of  the  corresponding  side.  They  end 
by  uniting  to  form  the  superior  vena  cava.  No  valves. 

The  right  innominate  vein  is  short  (i  inch  long),  and,  com- 
mencing behind  the  inner  end  of  the  clavicle,  passes  down- 
wards to  join  left  innominate  at  the  inferior  border  of  ist 
right  costal  cartilage.  Receives  the  right  vertebral,  right 
internal  mammary,  right  inferior  thyroid,  and  right  superior 
intercostal  veins.  The  right  lymphatic  duct  opens  at  the 
angle  of  union  of  right  subclavian  and  internal  jugular  veins. 

Relations : — 

In  Front.  Behind. 

Right  sterno-hyoid.  Right  pleura  and  lung. 

Right  sterno-thyroid. 
Clavicle. 

ist  costal  cartilage. 
Thymus. 

Left  Side.  Right  Side. 

Innominate    artery    and    right  Right  lung  and  pleura, 

pneumogastric  nerve.  Right  phrenic  nerve. 

The  left  innominate  is  3  inches  long,  passes  from  left  to  right 
and  downwards.  The  thoracic  duct  opens  at  the  angle  of 
union  of  the  left  subclavian  and  internal  jugular  veins. 

'left  vertebral, 
left  internal  mammary, 
left  inferior  thyroid. 

The  left  innominate  vein  receives-;  left  superior  intercostal. 

thymic. 
mediastinal. 
pericardiac. 
Relations : — 

In  Front.  Below. 

First  piece  of  sternum.  Arch  of  aorta  (transverse  part). 

Origin  of  left  sterno-hyoid.  „  , .     , 

Origin  of  left  sterno-thyroid.  **** 

Thymus  gland.  Innominate  artery. 

Left  ca»  otid  artery. 
Left  subclavian  artery. 
Left  phrenic  nerve. 
Left  pneumogastric  nerve. 


104  THE  POCKET  ANATOMY 

Internal  mammary :  two  with  each  artery,  uniting  in  a 
single  trunk,  emptying  into  innominate  veins. 

Inferior  thyroid  (sometimes  3  or  4) :  from  thyroid  venous 
plexus,  emptying  into  right  and  left  innominate  veins. 

Superior  intercostal :  receives  veins  from  2nd  and  3rd 
intercostal  spaces.  The  right  one  passes  down  and  enters  the 
azygos  major,  the  left  passes  forward  across  arch  of  aorta 
to  left  innominate  vein,  and  receives  the  left  bronchial 
vein. 

Vena  cava  superior  :  3  inches  long,  formed  by  the  junction 
of  the  right  and  left  innominate  veins  behind  the  junction  of 
the  ist  right  costal  cartilage  with  the  sternum  ;  passes  down 
to  the  right  auricle  opposite  upper  border  of  3rd  right  costal 
cartilage.  The  vena  cava  enters  the  pericardium  about 
i£  inches  from  its  termination,  and  this  part  is  covered  with 
serous  membrane  except  posteriorly.  No  valves.  Receives 
pericardial  and  mediastinal  veins,  and  just  as  it  enters  the 
pericardium  the  azygos  major  vein. 

Relations : — 

Left  Side.  In  Front.  Right  Side. 

Innominate     artery,     in         Pleura.  Pleura. 

upper  part.  Thymus  gland.  Right  phrenic  nerve. 

Ascending  part  of  aortic        Costal  cartilages  and 
arch,  in  lower  part.  intercostal  spaces. 

Pericardium. 

Behind. 
Pleura. 

Right  bronchus. 
Right  pulmonary  artery. 
Upper  right  pulmonary  vein. 
Pericardium. 

Azygos  major:  commencing  opposite  ist  or  2nd  lumbar 
vertebra  by  a  branch  from  right  lumbar  veins,  passes  up 
through  aortic  opening  in  diaphragm  to  right  of  aorta,  and 
along  right  side  of  column  in  front  of  right  intercostal 
arteries  to  3rd  dorsal  vertebra,  where,  arching  over  root  of 
right  lung,  it  empties  into  superior  vena  cava.  Receives  the 
ten  lower  right  intercostal  veins,  venae  azygoi  minores 
(superior  and  inferior),  several  cesophageal,  mediastinal,  and 
right  bronchial  veins.  Imperfect  valves,  though  its  branches 
have  complete  ones. 

Azygos  minor  inferior :  commencing  in  lumbar  region  of  left 
side  from  lumbar  veins,  or  branches  of  renal,  passes  through 
left  crus  of  diaphragm  to  8th  dorsal  vertebra,  there  crossing 
behind  aorta  and  thoracic  duct  to  terminate  in  azygos  major. 


VEINS  105 

Receives  three  or  four  lower  left  intercostals ;  some  ceso- 
phageal  and  mediastinal  veins. 

Azygos  minor  superior:  formed  by  union  of  4th,  5th,  6th, 
7th,  and  8th  left  intercostal  veins  ;  communicates  above  with 
superior  intercostal  vein,  crosses  yth  dorsal  vertebra  behind 
aorta  and  thoracic  duct  to  end  in  vena  azygos  major. 

Bronchial :  from  lungs ;  the  right  terminating  in  azygos 
major  ;  the  left  in  the  left  superior  intercostal. 

SPINAL  :  Dorsi-spinales ;  external  to  spinal  canal,  extend 
along  whole  length  of  back  of  spine,  forming  network,  ter- 
minating in  the  vertebral  (of  neck),  the  intercostal  (of  thorax), 
lumbar  and  sacral  veins. 

Meningo-rachidian  :  situated  between  vertebra  and  dura 
mater,  consisting  of  longitudinales  spinales  anteriores :  whole 
length  of  anterior  surface  of  vertebral  canal,  terminating  in 
dorsi -spinal. 

Longitudinales  spinales  posteriores :  whole  length  of  posterior 
surface  of  vertebral  canal,  terminating  in  dorsi-spinal. 

Veins  of  the  vertebrae  :  Vena  basis  vertebrarum  :  from  bodies 
of  vertebras,  terminating  in  anterior  longitudinal. 

Veins  of  the  spinal  cord :  Medulli-spinales :  cover  cord, 
between  pia  and  arachnoid,  from  sacrum  to  occiput;  anas. 
freely  with  contiguous  veins.  No  valves  in  any  of  the  spinal 
veins. 

Iliaca  externa,  interna,  and  communis :  see  Lower  Ex- 
tremity. 

Vena  cava  inferior  :  formed  by  junction  of  the  two  common 
iliac  veins  in  front  and  a  little  to  the  right  of  5th  lumbar 
vertebra,  passes  up  on  right  side  of  aorta  to  posterior  border 
of  liver,  where  it  becomes  imbedded  in  a  groove  and  receives 
the  hepatic  veins ;  thence  it  goes  through  special  opening  in 
diaphragm  between  middle  and  right  leaflets,  enters  pericar- 
dium, and  opens  into  lower  and  back  part  of  right  auricle, 
its  orifice  being  protected  by  the  Eustachian  valve. 

Relations  : — 

In  Front.  Behind.  Left  Side. 

Mesentery.  Vertebral  column.  Descending  aorta 

Transverse  part  of  duo-        Right     crus     of     dia-        Right  crus. 

denum.  phragm  and  psoas. 

Pancreas.  Right  renal  ^ 

Foramen  of  Winslow.  Right  lumbar  _    • 

Portal  vein.  Right  supra-renal         Arteries. 

Posterior  surface  of  liver.         Right  inferior  phrenic,/ 
Hepatic  ^ 

Right  spermatic  . 

Riiht  colic  r  arteries. 

Right  common  iliac  } 
Diaphragm. 


io6  THE  POCKET  ANATOMY 

flumbar  branches, 
right  spermatic, 
(ovarian  in  female). 

The  inferior  vena  cava   riSht  renal- 
receives      

right  supra- renal, 
inferior  phrenic, 
hepatic. 

CARDIAC  VEINS  :  Vena  cordis  magna :  from  apex,  up  an- 
terior interventricular  groove  to  base  of  ventricles,  curving 
to  left  side  and  back  part  of  heart,  empties  into  coronary 
sinus ;  guarded  by  two  valves ;  receives  posterior  cardiac  and 
left  cardiac  veins. 

Venae  cordis  mediae  (posterior  cardiac) :  from  apex  up  pos- 
terior interventricular  groove,  terminating  in  coronary  sinus, 
guarded  by  valves. 

Venae  parvae  (anterior  veins)  :  three  or  four  small  branches 
from  anterior  surface  of  right  ventricle,  emptying  into  lower 
part  of  right  auricle. 

Venae  Thebesii :  drain  muscular  substance,  opening  into 
right  auricle. 

Bight  or  small  coronary :  from  back  of  right  auricle  and 
ventricle,  runs  in  auriculo-ventricular  groove  to  open  in  right 
end  of  coronary  sinus. 

The  coronary  sinus :  is  the  part  of  the  great  cardiac  vein 
which  is  placed  in  the  left  auriculo-ventricular  groove.  Is 
i  inch  in  length,  and  opens  in  the  right  auricle,  the  opening 
being  guarded  by  the  Thebesian  valve.  Receives  branches 
as  above,  and  a  small  straight  vein  at  the  back  of  the  left 
auricle,  the  oblique  vein  of  Marshall,  the  remnant  of  the  left 
superior  vena  cava  of  the  foetus. 

Pulmonary :  four  in  number ;  commence  in  capillary  net- 
work upon  the  pulmonary  alveoli,  uniting  to  form  a  trunk  for 
each  lobe  ;  the  one  of  the  middle  lobe  of  the  right  lung  unites 
with  the  one  from  the  superior  lobe,  hence  there  are  two 
veins  from  each  side.  No  valves.  Carry  arterial  blood  and 
empty  in  to  the  left  auricle,  the  left  veins  crossing  the  descend- 
ing thoracic  aorta. 

Relations  at  the  root  of  the  lung : — 

From  A  dove  Down. 
From  Before  Back.  reside.  Left  Sid*. 


Vein.  Bronchus.  Artery. 

Artery.  Artery.  Bronchus. 

Bronchus.  Vein.  Vein. 


VEINS  107 


THE  PORTAL  SYSTEM. 

The  veins  of  the  portal  system  collect  the  blood  from  the 
digestive  tract.  They  form  a  trunk,  the  vena  portse,  which 
enters  the  liver  and  breaks  up  into  small  branches  in  its  sub- 
stance. The  following  veins  form  the  portal  system  : — 

Inferior  mesenteric :  drains  rectum,  pelvic,  iliac,  and 
descending  colon.  It  lies  to  the  left  of  its  artery,  and  passing 
behind  transverse  part  of  the  duodenum  and  the  pancreas, 
and  over  left  kidney,  opens  into  the  splenic  vein.  (The 
haemorrhoidal  branches  anastomose  with  the  haemorrhoidal 
branches  of  the  internal  iliac.) 

Superior  mesenteric :  drains  small  intestines,  caecum, 
ascending  and  descending  colon.  It  passes  upwards  in  front 
and  to  right  of  superior  mesenteric  artery,  in  front  of  trans- 
verse part  of  duodenum,  and  behind  neck  of  pancreas  joins 
the  splenic  vein  at  the  upper  border  of  the  pancreas  to  form 
the  portal  vein. 

Splenic :  commences  in  five  or  six  tributaries  in  hilum  of 
spleen ;  these  unite  to  form  a  trunk  which  passes  below 
splenic  artery  from  left  to  right,  behind  upper  border  of  pan- 
creas, and  in  front  of  aorta ;  joins  superior  mesenteric  at  a 
right  angle. 

The  gastric  or  coronary :  a  large  vein  accompanying  coron- 
ary artery  from  right  to  left  along  lesser  curvature  of  stomach 
to  cardia,  where  it  receives  cesophageal  tributaries,  and, 
passing  to  right  behind  lesser  sac,  opens  into  the  vena  portae. 

The  vena  portsa  :  is  formed  by  the  union  of  the  splenic  and 
superior  mesenteric  veins  in  front  of  the  right  crus  of  dia- 
phragm and  inferior  vena  cava,  and  behind  the  neck  of  the 
pancreas.  Passes  up  behind  first  part  of  duodenum  and  then 
between  the  layers  of  the  small  omentum,  behind  and  between 
the  common  bile-duct  and  hepatic  artery,  the  duct  being  placed 
on  the  right  and  artery  on  the  left,  to  transverse  fissure  of  liver ; 
here  it  divides  into  right  and  left  branches  to  corresponding 
lobes,  and  also  gives  an  offset  to  the  Spigelian  lobe.  Con- 
nected with  the  branch  to  the  left  lobe  are  in  front  the  obliterated 
umbilical  vein  and  behind  the  ductus  venosus,  the  remains  of  a 
f  jetal  connection  with  the  inferior  vena  cava. 


io8 


THE  POCKET  ANATOMY 


The  portal 
vein    re-< 
ceives  .. 


splenic 


superior  mesen- 
teric  .. 


gastric  or  coronary, 
pyloric. 
Lcystic. 


splenic  bran- 
ches. 

vasa  brevia  of 
stomach. 

pancreatic. 

left  gastro-epi- 
ploi'c. 


inferior 
senteric 


Heft  colic. 

me- 1  siSmo.id- 
-|  superior 

*  *  I      haemor- 
rhoidal. 


intestinal, 
ileo-colic. 
right  colic, 
middle  colic, 
right     gastro- 

epiploi'c. 
pancreatic, 
pancreatico- 

duodenal. 


VEINS  OF  THE  LOWER  EXTREMITY. 


SUPERFICIAL   SET. 

Internal  or  long  saphenous :  from  plexus  on  dorsum  and 
inner  side  of  foot ;  ascends,  in  front  of  inner  ankle,  behind 
inner  margin  of  tibia,  accompanied  by  internal  saphenous 
nerve ;  bends  behind  inner  condyle  of  femur,  ascends  along 
inner  side  of  thigh,  through  saphenous  opening,  empties  into 
femoral  i£  inches  below  Poupart's  ligament,  where  it  receives 
superficial  circumflex  iliac,  superficial  epigastric,  and  superficial 
external  pudic.  Communicates  with  internal  plantar,  tibial, 
etc.  Two  to  six  valves. 

External  or  short  saphenous  :  from  plexus  on  dorsum  and 
outer  side  of  foot,  up  behind  outer  ankle  to  median  line  of 
leg,  accompanied  by  external  saphenous  nerve ;  empties  into 
popliteal  vein,  between  the  heads  of  the  gastrocnemius.  Two 
valves,  one  near  termination.  Communicates  with  deep  veins 
of  foot. 


VEINS 


109 


DEEP   SET. 

Posterior  tibial :  two  venae  comites,  formed  from  external 
and  internal  plantar,  joining  with  the  peroneal.  Course  same 
as  artery. 

Anterior  tibial :  two  venae  comites,  continuation  of  vena 
dorsales  pedis,  pierce  interosseous  membrane  at  upper  part  of 
leg,  and  form  the  popliteal  vein,  by  junction  with  the  pos- 
terior tibial  veins,  at  the  lower  border  of  the  popliteus  muscle. 

Popliteal  (see  anterior  tibial) :  passes  up  to  femoral  aper- 
ture in  adductor  magnus,  there  becoming  the  femoral ;  re- 
ceives sural,  articular,  and  external  saphenous  veins.  Four 
valves.  Placed  superficial  to  artery,  which  it  crosses  as  it 
ascends,  from  within  outwards. 

Femoral  (see  above)  :  passes  from  the  opening  in  the 
adductor  magnus  up  to  Poupart's  ligament,  there  becoming 
external  iliac.  Lies  at  first  to  outer  side  of  artery,  but  higher  up 
crosses  behind  to  its  inner  side.  Receives  muscular  branches, 
profunda  femoris,  and  the  internal  saphenous.  Four  or  five 
valves. 

External  iliac  (see  above) :  from  Poupart's  ligament  to 
sacro-iliac  synchondrosis,  there  uniting  with  the  internal  iliac 
to  form  common  iliac.  On  right  side,  lies  to  inside  of  artery 
at  first,  but  gradually  passes  behind  it.  On  left  side,  alto- 
gether on  inside  of  artery.  Receives  deep  epigastric  and  deep 
circumflex  iliac,  and  a.  pubic  vein  from  the  obturator. 

Internal  iliac :  formed  by  the  union  of  all  of  the  venae 
comites  of  the  branches  of  the  internal  iliac  artery,  except 
the  ilio-lumbar  veins  which  open  into  the  common  iliac.  It 
lies  at  first  on  the  inner  side,  but  finally  gets  behind  the  artery. 
It  has  no  valves.  The  visceral  veins  opening  into  the  internal 
iliac  anastomose  very  freely  and  form  a  series  of  plexuses. 


C  superior  and 
haemorrhoidal  I      middle 
plexus       . .  j     haemor- 
\     rhoidal. 


The  internal 
iliac  vein 
receives 


visceral 
branches 


fvesical. 

vesico-prosta- 1  dorsal  of  penis, 
tic  plexus  . .  1  deep  veins  of 

\.     penis, 
uterine 


no 


THE  POCKET  AN 'ATOM Y 


The  internal 
iliac  vein 
receives 


parietal 
branches 


obturator. 


internal  pudic 


sciatic   ..     .. 

gluteal. 
.lateral  sacral. 


veins  of   corpus 

cavernosum. 
veins  of  bulb, 
transverse    peri- 

neal. 
superficial    peri« 

neal. 
inferior 

hsemorrhoidal. 
fcoccygeal. 
I  comes  nervi 
|     ischiadici. 
\  muscular. 


Common  iliac  (see  external  iliac) :  from  base  of  sacrum  to 
terminate  on  5th  lumbar  vertebra,  a  little  to  the  right  of  the 
middle  line,  where,  with  its  fellow  of  opposite  side,  it  forms 
vena  cava  inferior.  The  right  vein  is  the  shorter,  and  nearly 
vertical.  Receives  ilio-lumbar  and  sometimes  lateral  sacral 
veins.  Middle  sacral  empties  into  left  common  iliac.  No 
valves. 

Relations. — Right  vein  passes  behind,  and  then  to  right 
side  of  artery.  Left  vein  is  placed  on  inner  side  of  left  artery, 
and  then  passes  behind  right  common  iliac  artery  to  join 
right  vein,  crossing  middle  sacral  artery. 


THE  ABSORBENT  SYSTEM. 

The  thoracic  duct  receives  the  absorbents  from  both  lower 
limbs,  abdomen,  except  upper  surface  of  liver,  from  left  half 
of  thorax,  left  upper  limb,  and  left  side  of  head  and  neck. 

Length. — 15  to  18  inches. 

Extent. — From  2nd  lumbar  vertebra,  where  it  commences 
by  a  dilatation,  the  receptaculum  chyli,  to  junction  of  left 
internal  jugular  with  left  subclavian  vein. 
-  Relations. — The  abdominal  part  is  placed  on  the  front  of 
the  body  of  the  2nd  lumbar  vertebra,  behind  and  to  the  right 
side  of  the  aorta  and  on  the  inner  side  of  the  right  crus ;  it 
then  enters  the  thorax  through  aortic  opening,  on  the  right 
side  of  aorta,  lying  between  it  and  the  vena  azygos  major, 
and  passes  upwards  to  right  of  aorta  on  right  intercostal 


THE  ABSORBENT  SYSTEM  in 

vessels.  Opposite  the  4th  dorsal  vertebra  it  passes  to  the  left 
behind  aortic  arch,  and  runs  along  the  left  side  of  the  oeso- 
phagus, behind  the  left  common  carotid  artery.  At  the  level 
of  the  yth  cervical  vertebra  it  turns  outwards,  and  passing 
behind  left  internal  jugular  and  crossing  ist  part  of  left  sub- 
clavian  artery,  archies  over  the  apex  of  the  left  pleura  to 
open  at  the  angle  of  union  of  the  left  internal  jugular  and  left 
subclavian  veins. 

The  right  lymphatic  duct :  receives  the  absorbents  of  the 
right  limb,  right  side  of  chest,  right  half  of  head  and  neck, 
and  upper  surface  of  liver.  It  is  about  ^  inch  long,  and 
enters  the  venous  system  at  the  angle  of  union  of  the  right 
internal  jugular  and  right  subclavian  veins. 

THE  LYMPHATICS  OF  THE  HEAD  AND  NECK. 

Suboccipital  glands  (i  or  2) :  receive  lymphatics  from  back 
of  scalp,  efferent  vessels  join  superficial  cervical  glands. 

Mastoid  glands  (2  or  3)  :  receive  lymphatics  from  back  of 
ear  and  external  auditory  meatus,  efferent  vessels  join  super- 
ficial cervical  glands. 

Parotid  lymphatic  glands  (3  or  4) :  one  being  placed  just 
anterior  to  tragus.  Receive  lymphatics  from  temporal  region, 
external  auditory  meatus  and  eyelids ;  efferent  vessels  pass  to 
submaxillary  and  superficial  cervical  glands. 

Internal  maxillary  glands:  afferent  vessels  from  temporal, 
nasal,  zygomatic,  and  orbital  fossae,  palate  and  upper  part  of 
pharynx;  efferent  vessels  pass  to  superior  deep  cervical 
glands. 

Submaxillary  lymphatic  glands  (8  to  10) :  afferent  vessels 
from  face,  floor  of  mouth,  submaxillary  and  lingual  glands ; 
efferent  vessels  to  cervical  glands. 

Superficial  cervical  glands  (4  to  6) :  placed  along  the  ex- 
ternal jugular  vein.  Afferent  vessels  from  external  ear,  skin 
of  neck  ;  efferent  vessels  to  the  deep  cervical  glands. 

Deep  cervical  glands  (20  to  30) :  glandulas  concatenate. 

Superior:  lie  along  internal  jugular  vein  from  division  of 
common  carotid  to  base  of  skull.  Afferent  vessels  from  in- 
ternal maxillary  and  submaxillary  glands,  cranium,  tongue, 
larynx,  lower  part  of  pharynx  and  thyroid  body.  Efferent 
vessels  to  inferior  set. 

Inferior:  placed  along  lower  part  of  internal  jugular  vein. 
Afferent  vessels  from  other  cervical  glands  and  lower  part  of 
neck.  Efferent  vessels  form  a  single  trunk  {Jugular  lymphatic 
trunk),  opening  into  thoracic  duct  on  left  side,  and  into  the 
right  lymphatic  duct  on  right  side. 


THE  POCKET  ANATOMY 


THE    LYMPHATICS   OF   THE   UPPER   LIMB. 

The  lymphatics  of  the  arm  are  arranged  in  a  superficial 
and  a  deep  set  which  enter  the  axillary  glands,  except  a  few 
superficial  which  join  the  gland  over  the  internal  condyle. 

There  are  two  sets  of  lymphatic  glands  in  the  arm,  viz., 
superficial  and  deep. 

The  superficial  lymphatic  glands :  one  or  two  above  the 
internal  condyle  (epitrochlear). 

The  deep  lymphatic  glands  :  two  or  three  on  inner  side  of 
brachial  artery. 

The  axillary  glands  (10  or  12)  :  receive  the  lymphatics 
from  the  upper  limb. 

Axillary  set:  placed  along  axillary  vessels,  afferent  vessels 
from  limb. 

Pectoral  set:  placed  along  long  thoracic  artery,  afferent 
vessels  from  mamma  and  chest. 

Subscapular  set:  placed  along  subscapular  artery,  afferent 
vessels  from  the  back. 

Infra-clavicular  set:  situated  below  the  clavicle,  in  the 
hollow  between  pectoralis  major  and  deltoid  ;  afferent  vessels 
from  shoulder  and  efferent  vessels  from  pectoral  set. 

THE    LYMPHATICS   OF   THE   PELVIS   AND   ABDOMEN. 

External  iliac  glands  (6  to  10) :  lie  along  external  iliac 
artery ;  afferent  vessels  from  inguinal  glands. 

Internal  iliac  glands:  placed  along  internal  iliac  artery; 
afferent  vessels  from  pelvic  viscera. 

Sacral  glands :  placed  in  hollow  of  sacrum,  receive 
lymphatics  of  rectum. 

Lymphatics  of  bladder :  placed  near  base  of  bladder ; 
efferent  vessels  enter  internal  iliac  glands. 

Lymphatics  of  uterus :  in  the  impregnated  state  enter  in- 
ternal iliac  glands. 

Lumbar  lymphatic  glands  :  mesial  group,  surround  aorta 
and  vena  cava ;  afferent  vessels  from  external  and  internal 
iliac,  and  sacral  glands,  lymphatics  of  kidney,  supra-renal 
bodies,  testicles  (ovaries),  etc.  The  lateral  group  lie  behind 
psoas,  and  receive  the  deep  lymphatics  of  the  abdominal  wall. 
The  efferent  vessels  of  the  whole  enter  the  thoracic  duct. 

Mesenteric  glands  (130  to  150) :  disposed  around  the  trunk 
and  branches  of  the  superior  mesenteric  artery;  efferent 
vessels  go  to  the  thoracic  duct. 

Cceliac  glands  (16  to  20) :  surround  cceliac  axis.  The  afferent 


THE  ABSORBENT  SYSTEM  113 

vessels  come  from  stomach,  spleen,  pancreas,  and  liver ;  the 
efferent  vessels  go  to  the  thoracic  duct. 

THE   LYMPHATICS   OF   THE    THORAX. 

Sternal  glands  (6  to  10) :  along  internal  mammary  artery. 
The  afferent  vessels  come  from  front  of  chest  and  abdominal 
walls,  diaphragm  and  under  part  of  mamma ;  the  efferent 
vessels  join  anterior  mediastinal  glands  and  thoracic  duct. 

Intercostal  glands:  placed  posteriorly  on  heads  of  ribs. 
The  afferent  vessels  come  from  chest  wall ;  the  efferent  open 
into  the  thoracic  and  right  lymphatic  ducts. 

Anterior  mediastinal  glands  (3  or  4)  :  between  pericardium 
and  sternum.  The  afferent  vessels  come  from  lower  sternal 
glands,  upper  surface  of  liver  and  diaphragm  :  the  efferent 
vessels  pass  to  thoracic  and  right  lymphatic  ducts. 

Superior  mediastinal  or  cardiac  glands  (8  to  10) :  placed  in 
front  of  the  arch  of  the  aorta  in  the  superior  mediastinum. 
The  afferent  vessels  come  from  the  heart,  pericardium  and 
thymus  gland  ;  the  efferent  vessels  unite  in  two  or  threp 
trunks  which  open  into  the  thoracic  and  right  lymphatic 
ducts. 

Bronchial  glands :  are  placed  behind  and  between  the 
bronchi.  The  afferent  vessels  come  from  the  lung ;  the 
efferent  vessels  join  to  open  into  the  thoracic  and  right  lym- 
phatic ducts. 

Posterior  mediastinal  glands  (8  to  12) :  lie  along  descending 
thoracic  aorta.  The  afferent  vessels  come  from  the  oesophagus, 
pericardium,  and  diaphragm ;  the  efferent  vessels,  go  to  the 
thoracic  duct. 

THE    LYMPHATICS   OF   THE    LOWER   LIMB. 

The  lymphatics  of  the  lower  limb  are  divided  into  a  super- 
ficial and  a  deep  set.  The  superficial,  except  a  few  which  pass 
to  the  popliteal  glands,  go  to  the  superficial  inguinal  glands. 
The  deep  lymphatics  enter  the  deep  inguinal  glands. 

The  popliteal  glands  (4  or  5) :  are  placed  on  the  popliteal 
vessels.  The  afferent  vessels  come  from  the  lymphatics  of 
the  leg ;  the  efferent  go  to  the  inguinal  glands. 

The  superficial  inguinal  glands  (8  to  10) : 

Oblique  set:  lie  along  Ponpart's  ligament.  The  afferent 
vessels  come  from  trunk,  buttocks,  anal  canal,  perineum,  and 
external  genitals,  including  membranous  and  spongy  urethra 
in  the  male  and  lower  third  of  vagina  in  female. 

Vertical  or  femoral  set :  lie  along  the  internal  saphenous 
vein,  and  receive  the  superficial  lymphatics  of  the  limb. 
The  efferent  vessels  of  both  sets  join  the  deep  glands. 

8 


H4  THE  POCKET  ANATOMY 

The  deep  inguinal  glands :  surround  the  femoral  vessels 
(a  constant  one  in  the  crural  canal) .  The  afferent  vessels  come 
from  the  superficial  inguinal  glands  and  the  deep  lymphatics 
of  the  limb  ;  the  efferent  vessels  join  the  external  iliac  glands. 


THE  SPINAL  CORD. 

The  spinal  cord  is  the  part  of  the  cerebro-spinal  axis  whick 
occupies  the  spinal  canal.  In  the  adult  it  occupies  about 
§  of  the  length,  but  in  the  foetus,  before  the  third  month,  it 
extends  the  whole  length  of  the  canal. 

Extent. — The  spinal  cord  extends  from  the  lower  border  of 
the  foramen  magnum,  where  it  is  continuous  with  the  medulla 
oblongata  above,  to  the  lower  border  of  the  ist  lumbar  ver- 
tebra, there  terminating  in  a  slender  filament,  the  filum 
terminal*. 

Contents  of  the  Neural  Canal. 

Venus  plexus  between  bone  and  dura  mater. 

(  dura  mater. 
Membranes      <  arachnoid. 

(  pia  mater,  with  ligamenta  denticulata. 
Cerebro-spinal  fluid. 

So'nal    essels  i  anterior  sPinal  artery  and  vein. 

\  two  posterior  spinal  arteries  and  veins. 
Spinal  cord,  with  anterior  and  posterior  roots  of  nerves. 

Shape.—  In  transverse  section,  nearly  round,  except  at  the 
enlargements,  where  it  is  more  elliptical. 

Enlargements. — Presents  two  enlargements.  The  upper  or 
cervical  extends  from  the  upper  limit  of  the  cord  downwards 
to  the  ist  or  2nd  dorsal  vertebra. 

The  lower  or  lumbar  commences  opposite  the  loth  dorsal 
vertebra;  is  largest  at  the  1 2th  dorsal,  and  thence  tapers, 
forming  the  conns  medullaris,  from  the  tip  of  which  the  filum 
terminate  descends. 

The  filum  terminale  (central  ligament  of  the  cord) :  passes 
from  the  end  of  the  conus  medullaris  downwards  in  the  middle 
of  the  cauda  equina ;  becomes  closely  invested  with  dura 
mater  opposite  the  ist  or  2nd  sacral  vertebra,  and  blends 
with  the  periosteum  at  the  lower  end  of  the  sacral  canal. 

It  is  a  process  of  pia  mater,  containing  in  its  upper  half  the 
continuation  of  the  central  canal  of  the  cord,  together  with  a 
little  grey  matter  for  a  short  distance.  The  lower  half  con- 
sists of  connective-tissue,  bloodvessels  and  medullated  nerve- 


THE  SPINAL  CORD  115 

fibres.      The  anterior  spinal  artery  is  continued  along  the 
front ;  it  is  a  very  slender  vessel. 

The  nerve-roots. — Consist  of  anterior  and  posterior  bundles, 
31  pairs  (see  p.  158). 

The  anterior  roots  are  arranged  irregularly  along  the  side 
of  the  cord  ;  the  posterior  roots  issue  in  a  straight  line  along 
the  postero-lateral  groove.  They  are  distinguished  from  the 
anterior  roots  by  having  a  ganglion  and  by  their  larger  size. 

The  nerve-roots  pass  outward  to  the  intervertebral  fora- 
mina, those  in  the  upper  part  passing  almost  transversely ; 
below  they  pass  more  obliquely,  until  in  the  lower  part  of 
the  canal  their  course  is  vertical.  The  collected  bundles  of 
nerve-roots  at  the  termination  of  the  cord  form  the  cauda 
equina. 

FISSURES. 

Anterior  median  fissure  :  along  the  anterior  surface  of  the 
cord  in  the  middle  line.  Extends  into  the  substance  of  the 
cord  for  about  a  third  of  its  thickness,  but  deeper  below  than 
in  the  upper  part.  Does  not  reach  grey  matter.  Lined  with 
pia  mater. 

Posterior  median  fissure :  not  a  true  fissure,  and  only  con- 
tains a  septum  of  pia  mater.  Reaches  down  to  grey  matter. 

Lateral  fissures :  Antero-lateral :  not  a  true  fissure,  but  a 
line  corresponding  to  origin  of  anterior  nerve-roots. 

Postero-lateral :  corresponding  to  attachment  of  posterior 
nerve  roots. 

Columns  of  the  cord  : — 

The  cord  being  divided  into  two  lateral  halves  by  the 
median  fissures,  may  again  be  subdivided  into  anterior,  lateral, 
and  posterior  columns. 

The  posterior  and  lateral  columns  are  separated  by  a  groove 
or  lateral  sulcus,  to  which  the  posterior  nerve-roots  are 
attached. 

The  anterior  and  lateral  columns  are  separated  by  the  an- 
terior roots  of  the  nerves. 

The  posterior  column  is  subdivided  by  a  groove  (only  found 
in  the  upper  part  of  the  cord),  a  little  outside  the  posterior 
median  fissure,  into  two  columns,  the  postero-mesial  (of  Goll) 
and  the  postero-lateral  (of  Burdach). 

STRUCTURE   OF   THE    SPINAL   CORD. 

The  spinal  cord  in  transverse  section  consists  of  white 
matter  externally,  and  grey  matter  internally. 

The  grey  matter  :  consists  of  a  crescent-shaped  portion  it) 

8—2 


n6  THE  POCKET  ANATOMY 

each  lateral  half  of  the  cord,  united  by  an  intervening  pro- 
cess, the  posterior  or  grev  commissure. 

Each  crescent  has  two  cornua,  an  anterior,  thick  and  short, 
not  reaching  the  surface  of  the  cord ;  and  a  posterior,  long 
and  slender,  reaching  to  the  postero-lateral  fissure,  just  before 
reaching  which  it  becomes  enlarged,  caput  cornu,  and  becomes 
less  opaque  (substantia  gelatinosa  of  Rolando).  The  size  of 
the  grey  crescents  varies  in  different  parts  of  the  cord,  being 
largest  in  the  cervical  and  lumbar  enlargements.  In  the 
upper  dorsal  region  there  is  a  projection  of  the  grey  matter 
on  the  outer  side  of  the  crescent  between  the  anterior  and 
posterior  cornu,  called  the  intermedia-lateral  tract  or  lateral  cornu. 

Central  canal :  extends  through  the  whole  length  of  the 
cord  in  the  middle  of  the  posterior  or  grey  commissure.  It 
is  lined  with  a  spheroidal  ciliated  epithelium.  Opens  above 
into  the  floor  of  the  4th  ventricle,  and  is  continued  below  into 
the  upper  part  of  the  filum  terminale. 

The  white  matter  :  encloses  the  grey  matter  in  each  lateral 
half  of  the  cord,  except  where  the  posterior  cornu  comes  to 
the  surface.  The  portion  of  white  matter  between  the  pos- 
terior or  grey  commissure  and  the  anterior  median  fissure 
constitutes  the  anterior  or  white  commissure. 

THE   MEMBRANES   OF   THE   SPINAL   CORD. 

The  DURA  MATER  is  the  most  external  membrane,  and  is 
continuous  with  that  investing  the  brain ;  but  it  does  not 
form  the  periosteum  of  the  vertebrae,  nor  has  it  any  sinuses, 
but  is  separated  from  the  bones  by  areolar  tissue  and  a 
plexus  ot  veins.  It  is  connected  above  with  the  edge  of  the 
foramen  magnum  ;  at  the  top  of  the  sacrum  it  becomes  im- 
pervious, and  is  continued  as  a  slender  cord  to  blend  with  the 
periosteum  of  the  coccyx.  This  membrane  gives  sheaths  to 
all  the  spinal  nerves. 

The  PIA  MATER  is  less  vascular,  thicker,  and  more  fibrous 
than  that  investing  the  brain.  It  has  an  external  fibrous 
layer  of  longitudinal  bundles  having  a  fold,  the  linea  splendens, 
dipping  into  the  anterior  fissure,  and  a  smaller  one  passing 
into  the  posterior  fissure.  The  pia  mater  ends  in  a  slender 
cord,  the  filum  terminale,  which  is  within  the  prolongation  of 
the  dura  mater.  A  process  of  pia  mater,  the  ligamentum 
denticulatum ,  passes  outwards  towards  the  dura,  to  which  it  is 
attached  by  twenty-two  tooth-like  processes  situated  between 
the  origins  of  the  spinal  nerves  ;  its  pial  origin  is  continuous, 
and  lies  between  the  anterior  and  posterior  nerve-roots. 

The  ARACHNOID  is  placed  outside  the  pia  mater,  and  loosely 


THE  BRAIN 


117 


invests  the  cord.  The  subarachnoid  space  of  the  cord  is 
large,  and  is  imperfectly  divided  by  the  ligamentum  denticulatum, 
into  an  anterior  and  a  posterior  portion.  The  posterior  por- 
tion is  further  subdivided  by  the  septum  posticum,  which  passes 
from  the  posterior  fissure  backwards  to  the  opposite  part  of 
the  arachnoid,  and  contains  the  larger  bloodvessels.  Trabe- 
culse  also  pass  between  the  nerve-roots  and  the  inner  surface 
of  the  arachnoid,  and  between  the  posterior  nerve-roots  and 
the  septum  posticum. 

THE  BRAIN. 


Sylvian  aqueduct, 
crura  cerebri. 
corpora  quadri- 

gemina. 
3rd  ventricle, 
optic  thalami. 
pineal  body, 
posterior   perforated 

spot. 

corpora  albicantia. 
tuber  cinereum. 
pituitary  body, 
optic  commissure, 
lamina  cinerea. 
convolutions, 
fissures. 

corpus  callosum. 
lateral  ventricles. 
5th  ventricle, 
septum  lucidum. 
for  nix. 

foramen  of  Munro. 
velum  interpositum 
choroid  plexuses, 
corpora  striata. 
claustrum. 
tasnia  semicircularis 
nucleus  amygdalae, 
anterior  commissure. 


'medulla    ob- 
longata. 
cerebellum, 
pons  Varolii. 

s 

mesence- 
phalon  .  . 

thalamen- 
cephalon 

The  brain  . 
consists  of  ' 

cerebrum    .  .  < 

cerebral 
hemi- 
spheres.  • 

n8  THE  POCKET  ANATOMY 


THE    MEDULLA   OBLONGATA,    OR   BULB. 

Extent. — From  the  lower  border  of  the  foramen  magnum  to 
the  lower  border  of  the  pons  Varolii. 

Connections. — Inferiorly  it  is  connected  with  the  spinal  cord, 
superiorly  it  is  continued  into  the  pons,  anteriorly  it  rests 
upon  the  basilar  groove,  and  posteriorly  it  lies  in  a  depression 
between  the  hemispheres  of  the  cerebellum,  called  the  valle- 
cula,  and  here  bounds  the  lower  half  of  the  floor  of  the  4th 
ventricle. 

Dimensions. — 1£  inches  long  ;  greatest  breadth  f  inch. 

Shape. — Pyramidal,  with  base  at  the  pons,  and  apex  at  the 
spinal  cord. 

Fissures. — Anterior  and  posterior  median  fissures,  con- 
tinuous with  those  of  the  cord. 

Anterior  median  fissure:  terminates  just  below  the  pons  in 
the  foramen  cfscum.  The  fibres  of  the  anterior  pyramids  decus- 
sate at  the  lower  part  of  the  fissure,  and  partly  interrupt  it. 

Posterior  median  fissure  :  continues  up  from  the  cord  to  about 
half-way  up  the  medulla,  where  it  widens  out  into  the  fossa 
rhomboidalis  or  floor  of  the  4th  ventricle. 

Structure  of  the  medulla. — If  the  parts  of  the  spinal  cord 
are  traced  into  the  medulla,  its  structure  will  be  easily  under- 
stood. 

The  line  of  the  posterior  roots  of  the  spinal  nerves  is  continued 
by  the  upper  bundles  of  the  nerve-roots  of  the  spinal  acces- 
sory nerve,  above  this  by  the  bundles  of  the  vagus,  and 
above  this,  again,  by  the  bundles  of  the  glosso-pharyngeal 
nerve. 

The  line  of  exit  of  these  nerve-roots  represents  the  postero- 
lateral  groove  of  the  spinal  cord.  As  this  line  is  traced  up- 
wards it  turns  ventrally  outwards,  so  that  about  half-way  up 
the  medulla  it  appears  upon  the  lateral  surface,  and  in  its 
upper  part  it  lies  close  to  the  posterior  margin  of  the  olivary 
body,  from  which  it  is  separated  by  a  narrow  groove. 

The  part  behind  these  nerve-roots  is  termed  the  posterior 
area  of  the  medulla,  and  corresponds  to  the  posterior  columns 
(postero-mesial  and  postero-lateral)  of  the  cord. 

The  line  of  the  anterior  roots  of  the  spinal  nerves,  when 
traced  up  into  the  medulla,  deepens  into  a  groove  which  is 
continued  upwards  nearly  as  far  as  the  pons. 

The  bundles  of  the  nerve-roots  of  the  hypoglossal  issue 
from  this  groove.  The  part  of  the  medulla  between  this 
groove  and  the  anterior  median  fissure  is  called  the  anterior 
area,  and  corresponds  to  the  anterior  column  of  the  cord. 


THE  BRAIN  119 

The  part  between  the  anterior  and  posterior  areas — that  is, 
the  part  between  the  line  of  issue  of  the  nerve-roots  of  the 
spinal  accessory,  vagus,  and  glosso-pharyngeal  nerves,  and 
line  of  issue  of  the  nerve-roots  of  the  hypoglossal— is  called 
the  lateral  area,  and  corresponds  to  the  lateral  column  of  the 
cord. 

Posterior  area  of  the  medulla. — The  postero-mesial  column 
(of  Goll)  of  the  cord  is  continued  up  into  the  medulla  as  the 
funiculus  gracilis,  which  expands  as  it  approaches  the  4th 
ventricle.  This  expansion  is  called  the  clava ;  and  upon 
reaching  the  4th  ventricle  the  clavae  of  opposite  sides  open 
out  to  form  the  lateral  boundary  of  the  ventricle  in  its  lower 
part. 

The  postero-lateral  column  (of  Burclach)  of  the  cord  is 
continued  upwards  into  the  medulla,  where  it  expands  slightly, 
and  is  called  the  funiculus  cuneatus,  which,  on  the  same  level 
with  the  clava,  has  an  eminence,  the  cuneate  tubercle. 

Between  the  funiculus  cuneatus  and  the  line  of  origin  of  the 
nerve-roots  of  the  spinal  accessory,  vagus,  and  glosso-pharyn- 
geal, there  appears  in  the  lower  part  of  the  medulla  a  longi- 
tudinal prominence,  \he  funiculus  of  Rolando,  which  broadens 
out  above  into  the  tubercle  of  Rolando.  It  is  formed  by 
the  approach  of  the  caput  of  the  posterior  cornu  to  the 
surface. 

The  Restiform  body. — :In  the  upper  part  of  the  medulla,  a  set 
of  fibres  issue  from  the  anterior  median  fissure,  pass  trans- 
versely outwards  over  the  anterior  pyramid  and  olivary  body, 
and,  continuing  transversely,  cross  over  the  funiculus  of 
Rolando  and  the  cuneate  funiculus,  to  turn  upwards  on  these. 
They  are  the  superficial  arciform  or  arcuate  fibres,  and  are  mainly 
derived  from  the  gracile  and  cuneate  nuclei  of  the  same  and 
opposite  sides;  joined  to  these,  just  above  the  tubercle  of 
Rolando,  are  some  transverse  fibres  which  come  from  the 
lateral  column,  known  as  the  direct  cerebellar  tract.  These 
oblique  fibres  blend  with  the  funiculus  of  Rolando,  and  with 
the  superficial  fibres  of  the  funiculus  gracilis  and  funiculus 
cuneatus,  the  whole  forming  the  restiform  body.  Superiorly 
the  restiform  body  diverges  from  its  fellow  and  enters  the 
cerebellum,  of  which  it  forms  the  inferior  peduncle. 

Lateral  area  of  the  medulla. — The  lateral  column  of  the 
cord,  as  continued  into  the  medulla,  consists  of  three  sets  of 
fibres.  One  set,  the  crossed  pyramidal  tract,  crosses  obliquely 
through  the  anterior  column  and  across  the  anterior  median 
fissure  to  the  opposite  side,  where  they  form  the  greater  part 
of  the  pyramid.  A  second  set  coasts  o{  the  direct  cerebellar 


120  THE  POCKET  ANATOMY 

tract  which  join  the  restiform  body,  whilst  the  rest  of  the 
column  passes  upwards  as  far  as  the  lower  end  of  the  olive 
which  conceals  it. 

The  olivary  body  is  an  oval  prominence  lying  in  the  upper 
part  of  the  medulla,  between  the  pyramid  and  the  restiform 
body.  It  is  separated  from  the  pons  by  a  groove,  which  con- 
tains some  of  the  external  arcuate  fibres. 

On  the  inner  side  lie  the  nerve-roots  of  the  hypoglossal ; 
and  on  the  outer  side,  but  separated  from  it  by  a  groove,  the 
roots  of  the  accessory,  vagus,  and  glosso-pharyngeal  nerves 
issue.  Longitudinal  fibres,  prolonged  from  the  lateral 
column,  lie  in  the  groove  on  the  outer  side  of  the  olive, 
and  occasionally  a  few  bundles  of  longitudinal  fibres  are  seen 
on  the  inner  side.  These,  together  with  the  arched  fibres 
above  and  below,  give  it  the  appearance  of  being  enclosed  in 
a  capsule. 

The  fillet  of  the  olivary  body  is  a  small  bundle  of  fibres  derived 
from  the  capsule,  and  from  the  longitudinal  fibres  from  the 
lateral  tract.  The  fibres  ascend  in  the  crus  cerebri. 

Anterior  area  of  the  medulla. — Most  of  the  fibres  of  the 
anterior  columns  of  the  cord  are  prolonged  upwards  deeply 
beneath  the  pyramids,  but  a  bundle  varying  in  size  passes 
upwards  on  the  outer  side  of  the  crossed  portion  of  the  lateral 
column  (crossed  pyramidal  tract).  These  fibres  form  the 
direct  Pyramidal  tract. 

The  pyramids  are  two  oval  prominences,  broader  above 
than  below.  They  are  placed  one  on  each  side  of  the  anterior 
median  fissure.  They  consist  of  two  sets  of  fibres,  the  outer 
derived  from  the  anterior  column  of  the  cord,  the  inner  from 
the  lateral  column  of  the  opposite  side.  The  crossing  of  the 
two  sets  of  these  latter  fibres  constitutes  the  decussation  of  the 
Pyramids. 

The  fourth  ventricle.  The  central  canal  of  the  cord  ex- 
pands in  the  upper  and  posterior  part  of  the  medulla  until 
opposite  the  middle  peduncles  of  the  cerebellum,  where  it 
again  gradually  narrows,  and  becomes  continuous  with  the 
Sylvian  aqueduct  above.  The  floor  or  anterior  (ventral)  wall 
of  the  ventricle  is  thus  diamond-shaped.  The  lower  end  has 
been  compared  in  shape  to  a  pen,  and  is  hence  termed  the 
calamus  scriptorius. 

The  floor  in  the  lower  half  is  formed  by  the  upper  part  of 
the  posterior  surface  of  the  medulla,  and  in  the  upper  half  by 
the  back  of  pons  Varolii. 


THE  BRAIN  121 

Structures  on  the  floor. 
Lower  half. 
Median  groove. 

Inferior  fovea. — A  triangular  pit  on  each  side  of  the 
median  groove  near  the  striae  acusticae,  the  apex  being 
directed  upwards.  From  the  base  two  grooves  pass  down- 
wards, one  towards  the  calamus  scriptorius,  and  the 
other  towards  the  lateral  boundary.  Three  areas  are 
thus  marked  off  in  each  lateral  half  of  the  medullary 
portion : — 

1.  Trigonum  hypoglossi,  next  to  median  groove,  subjacent 

to  which  is  the  hypoglossal  nucleus. 

2.  Trigonum  vagi,  included  between  the  two  grooves 

passing  from  the  fovea.  Contains  nucleus  of  vagus 
below,  and  nucleus  of  glosso-pharyngeal  above. 

3.  Trigonum  acustici  (lower  half),  most  external,  con- 

tains chief  part  of  auditory  nucleus,  forming  part 
of  acoustic  tubercle. 

Upper  half. 
Median  groove. 

Superior  fovea. — A  triangular  depression  in  a  line  with 
the  inferior  fovea,  dividing  off  each  lateral  half  into  three 
areas,  viz.  : — 

1.  Fasciculus  teres,  most  internal,  here  raised  into  the 

eminentia  teres,  and  continuous  with  the  trigonum 
hypoglossi  below. 

2.  Locus    cceruleus,   a  depression    extending    from   the 

superior  fovea  to  the  upper  end  of  the  ventricle, 
beneath  which  is  some  pigment,  the  substantia 
nigra. 

3.  Tuberculum  acusticum  (upper  half). 

Issuing  from  the  median  groove,  and  passing  outwards  on 
each  side  over  the  middle  of  the  tuberculum  acusticum  are 
some  white  lines,  the  stria  acusticee. 

Lateral  recess. — This  is  a  lateral  extension  between  the  cere- 
bellum and  the  medulla  of  the  cavity  of  the  ventricle  at  its 
widest  part. 

The  roof :  in  the  lower  half  is  formed  by  pia  mater,  lineti 
with  epithelium.  It  has  three  apertures,  one  on  each  side  in 
the  lateral  recess,  and  the  third  at  the  apex  of  the  calamus 
scriptorius,  the  foramen  of  Majendie,  by  which  the  4th  ventricle 
communicates  with  the  subarachnoid  space. 

On  each  side  where  the  pia  mater  is  attached  laterally  to 


122  THE  POCKET  ANATOMY 

the  ventricle  it  is  thickened  by  white  matter,  and  is  termed 
the  ligula ;  and  at  the  apex  of  the  calamus  another  thickening, 
the  obex,  occurs.  Projecting  from  the  roof  on  each  side  of 
the  middle  line  is  the  choroid  plexus. 

In  the  upper  half,  the  roof  is  formed  by  the  converging 
superior  peduncles  of  the  cerebellum  and  the  intermediate 
superior  medullary  velum  or  valve  of  Vieussens,  continuous  with 
the  white  matter  of  the  cerebellum.  Grey  linear  thickenings 
on  the  valve  of  Vieussens,  continuous  with  the  grey  cerebellar 
cortex,  constitute  the  lingula. 

BOUNDARIES  OF  THE  4*TH  VENTRICLE. 

Laterally.  Floor.                               Roof. 
|  f  Clavseoffuniculigraciles.     Medulla  (below  .     Pia  mater  (below). 

"^  -?  Funiculi  cuneati.  Nodule  of  inferior  vermi- 

^  ^  Restiform  bodies.  Pons  (above).                form  process. 

^  ,-  Valve  of  Vieussens,  and 

§  I  Superior     peduncles  of                                        Superior    peduncles     of 

"*  \      cerebellum.  cerebellum  (above). 

Grey  Matter  of  the  Medulla. 

1.  Remains  of  grey  matter  of  cord. 

(a)  Grey  tubercle  of  Rolando,  from  posterior  cornu, 

appears  in  front  of  restiform  body. 

(b)  Remains  of  grey  commissure,  part  continued  into 

vagus  and  auditory  nuclei ,  and  part  into  fasciculus 
teres. 

(c)  Remains  of  anterior  cornu,  intersected  by  white 

fibres,  giving  rise  to  the  formatio  reticularis  of 
medulla. 

2.  bpecial  deposits  of  grey  matter. 

(a)  Nucleus  of  hypoglossal. 

(b)  Nucleus  for  accessory  part  of  spinal  accessory. 

(c)  Nucleus  of  vagus,  passing  above,  under  auditory 

nucleus,  into  nucleus  of  glosso-pharyngeal. 

(d)  Nucleus  of  glosso-pharyngeal. 

(e)  Nucleus  of  auditory  nerve. 

(/)  Corpus  dentatum,  or  nucleus  of  the  olivary  body. 
(g)  Accessory  olivary  nucleus. 

THE    PONS   VAROLII. 

Position. Placed  above  the  medulla,  below  the  cruracerebri, 

and  between  the  lateral  halves  of  the  cerebellum. 


THE  BRAIN  123 

Dimensions. — About  i£  inches  long,  and  about  2  inches 
transversely. 

Anterior  surface  is  convex,  grooved  along  the  midline  for  the 
basilar  artery  ;  has  transverse  markings,  and  openings  for  the 
entrance  of  vessels. 

Posterior  surface  :  smaller  than  the  anterior,  and  continuous 
with  the  posterior  surface  of  the  medulla ;  part  of  it  forms  the 
upper  part  of  the  floor  of  the  4th  ventricle. 

Laterally :  transverse  fibres  pass  outwards  and  backwards 
from  it,  forming  the  middle  cerebellar  peduncles. 

Upper  border  :  longer  than  the  inferior,  with  a  notch  in  the 
median  line  corresponding  to  the  groove  on  the  anterior 
surface. 

Lower  border :  slightly  arched,  overlapping  the  upper  part 
of  the  medulla. 

Structure:  Alternating  layers  of  transverse  and  longitu- 
dinal fibres,  with  intermingled  grey  matter.  The  transverse 
fibres  come  from  the  middle  peduncles  of  the  cerebellum,  and 
pass  to  the  crura  cerebri ;  the  longitudinal  are  the  continua- 
tion upwards  of  the  fibres  of  the  medulla. 

Most  anteriorly  is  a  layer  of  transverse  fibres  of  the  middle 
peduncles ;  behind  these,  longitudinal  fibres  prolonged  from 
the  anterior  pyramids  of  the  medulla  with  intermingled  trans- 
verse peduncular  fibres.  More  posteriorly  is  a  deep  layer  of 
transverse  fibres,  most  marked  at  the  lower  part  of  the  pons, 
where  they  form  the  corpus  trapezoides,  and  behind  these  are 
longitudinal  fibres  prolonged  from  the  formatio  reticularis  of 
the  medulla,  the  lateral  tract  and  the  olivary  fillet.  A  septum 
of  commissural  fibres  exists  at  the  posterior  part  of  the  pons. 

The  grey  matter  of  the  pons. — In  addition  to  the  grey  matter 
scattered  in  the  above-mentioned  formatio  reticularis  are  the 
following  special  deposits  : — 

(a)  Superior  olivary  nucleus.  Placed  posteriorly  near  the 
outer  side  of  the  corpus  trapezoides. 

(b)  Nucleus  of  the  facial  nerve.     Lies  in  formatio  reticu- 
laris, just  behind  superior  olivary  nucleus. 

(c)  Motor  nucleus  of  the  5th  nerve. 

(d)  Upper  sensory  nucleus  of  the  5th  nerve,  placed  outside 
motor  nucleus. 

(e)  Continuation  upwards  of  principal  auditory  nucleus. 
(/)  Superior  auditory  nucleus,  placed  just  outside  principal 

nucleus. 

Accessory  auditory  nucleus. 

k)  Nucleus  of  the  6th  nerve,  corresponding  to  the  part  of 
fasciculus  teres,  above  the  auditory  s*riae  (vide  4th  ventricle). 


(g) 
(h] 


124  THE  POCKET  ANATOMY 


THE   CEREBELLUM. 

The  cerebellum  is  contained  in  the  occipital  fossae,  being 
separated  from  the  cerebrum  above  by  the  tentorium.  It 
consists  of  two  lateral  hemispheres  connected  together  by 
the  vermiform  process,  which  projects  considerably  upon 
the  under  surface,  forming  the  inferior  vermiform  process; 
but  on  the  upper  surface  only  forms  a  slight  ridge,  the 
superior  vermiform  process,  continuous  with  the  hemispheres 
laterally. 

The  inferior  surface  of  each  hemisphere  is  convex,  and 
between  them  there  is  a  fossa,  the  vallecula,  at  the  bottom  of 
which  the  inferior  vermiform  process  lies,  and -which  is  con- 
tinuous posteriorly  with  a  notch  between  the  two  hemi- 
spheres. The  medulla  is  in  contact  with  the  anterior  part 
of  the  vallecula,  and  the  posterior  part  receives  the  falx 
cerebelli. 

Laminae  and  fissures.  The  surface  of  the  cerebellum 
consists  of  lamina,  which  are  separated  by  sulci  or  fis- 
sures. 

The  great  horizontal  fissure  divides  each  hemisphere  into  an 
upper  and  a  lower  part.  It  commences  at  the  pons  in  front, 
and  passes  horizontally  round  the  circumference  to  end  at 
the  notch  behind. 

Lobes.  On  the  upper  surface  of  the  cerebellum  are  the 
following  lobes : — 

(a)  Central :  a  small  lobe,  forming  the  anterior  part  of  the 
superior  vermiform  process.     It  is  continued  forwards  on  to 
the  valve  of  Vieussens,  forming  the  lingula  (vide  roof  of  4th 
ventricle,  p.  122),  and  laterally  on  to  each  hemisphere  by  a 
winglike  fold,  the  ala. 

(b)  Lobus  culminis  :  the  culmen  monticuli  forms  the  highest 
part  of  the  superior  vermis,  and  on  each  side  is  continuous 
with  the  anterior  crescentic  lobe  of  the  lateral  hemisphere ; 
posteriorly  the  sulcus  preclivalis  separates  it  from — 

(c)  Lobus  clivi :  consists  of  the  mesial  clivus  monticuli,  connect- 
ing on  either  side  the  two  posterior  crescentic  lobes,  which  are 
broad. 

(d)  Lobus  cacuminis :  behind  the  sulcus  postclivalis,  con- 
sists of  a  single  folium  of  the  superior  vermis,  folium  cacu- 
minis, connecting  the  large  postero-superior  lobes  of  the  lateral 
hemisphere. 


THE  BRAIN  125 

On  the  under  surface  of  the  cerebellum  are  the  following 
lobes  from  before  backwards : 

(a)  Lobus  noduli,  comprising  the  nodule  of  the  inferior  vermis 
and  the  flocculus  of  each  side,  with  a  delicate  connecting  white 
lamina,  inferior  medullary  velum. 

(b)  Lobus  uvula. — The  uvula  forms  a  considerable  part  of 
inferior  vermis  ,  it  is  connected  by  a  low  ridge,  the  furrowed 
band  crossing  the  sulcus  valleculae,  with  the  prominent  tonsil 
or  amygdala. 

(c)  Lobus  pyramidis :   the   prominent   mesial  pyramid  con- 
tinuous laterally  with  the  biventral  lobes. 

(d)  Lobus  tuberis :  comprises  the  tuber  valvula,   which  is 
the  posterior  part  of  the  inferior  vermis  and  the  postero- 
inferior  lobes  of  the  lateral  hemisphere;    the  latter  is  sub- 
divided into  lobus  gracilis  in  front  and  inferior  semilunar  lobe 
behind. 


STRUCTURE. 

White  matter  :  in  each  hemisphere  there  is  a  central  white 
mass,  containing  in  its  middle  a  grey  nucleus,  the  corpus 
dentatum. 

The  white  centre  sends  processes  into  the  laminae,  and  is 
prolonged  anteriorly  into  the  crus  cerebelli,  which  divides 
into  three  peduncles,  viz.  : — 

Superior  peduncle :  passes  to  the  base  of  the  corpora  quad- 
rigemina  and  cerebrum. 

Connecting  the  bases  of  the  two  superior  peduncles  is  the 
valve  of  Vieussens. 

Middle  peduncle  (the  cerebellar  commissure)  :  forms  the 
transverse  fibres  of  the  pons. 

Inferior  peduncle  :  connects  the  cerebellum  with  the  medulla 
and  cord  ;  it  passes  downwards  at  the  back  of  the  medulla, 
forming  the  restiform  body. 

The  white  matter  in  the  vermiform  processes  consists 
of  a  central  part,  projecting  into  the  laminae  of  the  pro- 
cesses. 

Anteriorly  it  is  continued  into  the  inferior  medullary 
velum. 

Grey  matter  of  the  hemispheres : 

A  cortical  layer :  forming  a  continuous  covering  of  the  cere- 
bellum. 


126  THE  POCKET  ANATOMY 

The  corpus  dentatum,  or  ganglion  of  the  cerebellum,  is  a 
dentated  capsule  of  grey  matter  enclosing  white  substance, 
situated  in  the  middle  of  the  white  matter  of  the  hemisphere. 
It  is  open  at  its  anterior  part,  whence  white  fibres  issue, 
passing  to  the  superior  peduncles  and  valve  of  Vieussens. 

Nucleus  emboliformis  :  covering  hilum  of  corpus  den- 
tatum. 

Nucleus  globosus  :  placed  on  the  inner  side  of  the  preceding, 
but  at  a  lower  level. 

Nucleus  fastigii :  in  the  anterior  part  of  the  white  centre  of 
the  vermiform  process. 

The  arrangement  of  white  and  grey  matter  in  the  cere- 
bellum gives  on  section  an  arborescent  appearance,  the  arbor 
vita. 

THE   MESENCEPHALON. 

The  Sylvian  aqueduct  (iter  a  tertio  ad  quartum  ventriculum) 
is  about  ^  inch  long.  Posteriorly  it  is  continuous  with  the 
narrowed  upper  end  of  the  4th  ventricle,  and  anteriorly  it 
opens  out  into  the  3rd  ventricle.  It  has  a  ciliated  epithelial 
lining,  and  outside  this  a  layer  of  grey  matter,  both  being 
continuous  with  corresponding  parts  of  the  4th  ventricle. 
Laterally  and  below  are  the  crura  cerebri,  whilst  posteriorly 
is  the  lamina  quadrigemina  bearing  the  corpora  quadri- 
gemina. 

The  grey  matter  of  the  aqueduct  contains  the  nuclei  of 
the  3rd  and  4th  nerves,  and  the  upper  nucleus  of  the 
5th  nerve. 

The  crura  cerebri  extend  from  the  upper  border  of  the 
pons,  and,  diverging,  pass  under  the  optic  tract  into  the 
cerebral  hemispheres.  Between  the  crura  is  the  interpedun- 
cular  space,  containing  the  posterior  perforated  spot,  the  cor- 
pora albicantia,  pituitary  body,  infundibulum,  and  the  tuber 
cinereum.  Near  the  angle  of  divergence  the  roots  of  the  3rd 
nerve  issue  from  a  groove  on  the  inner  side,  which  groove 
indicates  the  separation  of  the  ventral  part  (crusta  or  pes 
pedunculi)  from  the  dorsal  portion  (tegmentum)  of  the 
crus. 

There  is  a  layer  of  grey  matter  placed  between  the  pes 
pedunculi  and  the  tegmentum,  known  as  the  substantia  nigra 
or  locus  niger. 

The  pes,  or  crusta  pedunculi,  consists  of  longitudinal  white 
fibres,  of  which  the  middle  third  are  continuous  with  the 
anterior  pyramid  of  the  medulla,  and  pass  to  the  internal 
capsule. 


THE  BRAIN  127 

The  tegmentum  consists  of  white  longitudinal  fibres  and 
interspersed  grey  matter,  continuous  with  the  formatio  reticu- 
laris  of  the  medulla  and  pons,  and  passing  above  into  the 
optic  thalamus.  Two  more  or  less  definite  white  longitudinal 
tracts  are  here  passing  upwards,  the  fillet  and  the  superior 
cerebellar  peduncle,  which  latter  decussates  with  its  fellow 
beneath  the  aqueduct. 

The  corpora  quadrigemina  are  four  small  bodies  placed  in 
pairs,  superior  and  inferior  corpora  quadrigemina. 

Relations : — 


In  front.  Above.  Below, 

3rd  ventricle.  Posterior  border  of  Aqueduct  of 

Posterior  commissure.  corpus  callosum.  Sylvius. 

The  corpora  quadrigemina  of  opposite  sides  are  separated 
by  a  longitudinal  groove,  which  is  connected  below  with  the 
superior  medullary  velum ;  the  superior  corpora  quadri- 
gemina are  partly  concealed  by  the  overlying  pineal  gland. 
From  the  outer  side  of  each  corpus  there  proceeds  a  white 
tract,  the  brachium.  The  brachia  from  the  inferior  corpora 
go  to  the  inner  geniculate  body,  and  the  brachia  from 
the  superior  bodies  pass  into  the  optic  tract  between 
the  inner  geniculate  body  on  the  one  hand,  and  the 
optic  thalamus  and  the  external  geniculate  body  on  the 
other  hand. 

Structure. — The  inferior  bodies  consist  of  a  grey  nucleus 
enclosed  in  a  thin  capsule  of  white  fibres.  The  white 
fibres,  separating  the  nuclei  and  the  grey  matter  of  the 
aqueduct,  are  derived  from  the  fillet  of  the  olivary  body. 
The  nuclei  of  each  side  are  connected  by  commissural  grey 
;Jiatter. 

The  superior  bodies  consist  of  a  grey  nucleus  intersected  by 
white  longitudinal  fibres. 

THE   THALAMENCEPHALON. 

The  third  ventricle  is  the  narrow  space  between  the  optic 
thalami,  extending  from  the  opening  of  the  Sylvian  aqueduct 
under  the  posterior  commissur0,  to  the  foramen  of  Monro. 
It  is  much  deeper  in  front  than  behind. 

The  third  ventricle  communicates  above  by  the  Y-shaped 
foramen  of  Monro  with  the  lateral  ventricles  and  behind  with 
the  4th  ventricle  by  the  aqueduct  of  Sylvius. 


128  THE  POCKET  ANATOMY 

Boundaries  : — 

Roof.  Floor.  Laterally. 

Fornix.  Lamina  cinerea.  Optic  thalamus. 

Velum  interpositum  with  Optic  commissure.  Peduncles  of  pineal 

choroid  plexus  of  3rd  Tuber  cinereum.  gland, 

ventricle.  Infundibulum.  j^-u_j 

Corpora  albicantia.  Anteriorly. 

Posteriorly.  Posterior    perforated  Pillars  of  fornix. 

Pineal  gland.  spot.  Foramen  of  Monro. 

Posterior  commissure.  Tegmenta    of    crura  Anterior  commissure. 

Sylvian  aqueduct.  cerebri. 

Commissures  :  the  anterior  commissure  will  be  described 
with  cerebral  hemispheres. 

The  posterior  commissure :  is  a  commissural  layer  of  white 
fibres  connecting  the  two  optic  thalami  posteriorly.  It  forms 
the  posterior  boundary  of  the  3rd  ventricle,  being  placed  just 
above  the  upper  opening  of  the  aqueduct  of  Sylvius,  and 
beneath  the  pineal  body. 

The  middle  or  soft  commissure:  a  delicate  band  of  grey 
matter  passing  between  the  optic  thalami,  near  middle  of 
ventricle. 

The  optic  thalami.  Two  oblong  masses  of  grey  matter, 
covered  with  a  thin  layer  of  white  fibres,  the  stratum  zonale, 
and  projecting  above  into  the  lateral  ventricles. 

Upper  surface  :  there  is  a  groove  along  this  surface,  running 
from  behind  obliquely  forwards  and  inwards,  which  corre- 
sponds to  the  free  lateral  edge  of  the  fornix  and  divides  it 
into  two  pear-shaped  pieces,  the  outer  (ventricular  area)  having 
its  base  forwards  and  projecting  in  front,  forming  the  anterior 
tubercle,  and  the  inner  (extra- ventricular  area)  having  its  base 
behind  and  to  the  inner  side,  which  forms  ihe  posterior  tubercle 
or  pulvinar.  This  surface  is  separated  from  the  mesial,  or 
surface  bounding  the  3rd  ventricle,  by  the  peduncle  of  the 
pineal  body;  and  between  this  and  the  pulvinar  is  a  trian- 
gular depressed  surface,  the  trigonum  habenula.  This  surface 
is  partly  covered  by  the  fornix  resting  on  the  velum  inter- 
positum, and  is  separated  externally  from  the  caudate  nucleus 
by  the  taenia  semicircularis. 

Posterior  extremity  is  formed  chiefly  by  the  pulvinar.  Below 
and  outside  this  is  the  eminence  of  the  outer  geniculate  body ; 
and  just  below  this  is  the  inner  geniculate  body,  the  brachium 
from  the  superior  corpus  quadrigeminum  passing  between 
them. 

Under  surface  :  placed  on  the  tegtnentum  of  the  crus. 

External  surface  :  fibres  of  the  crusta  (internal  capsule)  pass 
between  this  surface  and  the  lenticular  nucleus,. 


THE  BRAIN  129 

Internal  surface :  forms  lateral  wall  of  3rd  ventricle,  and  is 
covered  by  ependyma. 

Anterior  extremity  (anterior  tubercle)  :  posterior  boundary 
of  foramen  of  Monro. 

The  pineal  body  is  a  cone-shaped  body  placed  at  the  back 
of  the  3rd  ventricle,  and  overlying  the  superior  quadrigeminal 
bodies.  The  3rd  ventricle  projects  backwards  into  its  base  or 
peduncle  (pineal  recess),  which  is  thus  divided  into  a  dorsal 
part,  connecting  the  pineal  body  on  each  side  with  the  optic 
thalamus,  and  a  ventral  part,  connecting  it  with  the  posterior 
commissure. 

The  posterior  perforated  spot  is  a  depression  containing 
grey  matter  placed  at  the  base  of  the  brain,  in  the  angle  of 
divergence  of  the  crura.  It  is  bounded  by  the  corpora  albi- 
cantia  in  front,  and  by  the  pons  behind.  The  anterior  part 
corresponds  to  the  under  portion  of  the  floor  of  the  3rd  ven- 
tricle, and  is  perforated  for  bloodvessels  to  the  optic  thalami. 

The  corpora  albicantia  are  two  small  whitish  bodies,  placed 
in  front  of  the  posterior  perforated  spot  and  behind  the  tuber 
cinereum.  They  consist  of  grey  matter  covered  with  white 
fibres,  derived  from  the  anterior  pillars  of  the  fornix. 

The  tuber  cinereum  is  an  eminence  of  grey  matter,  situated 
in  front  of  the  corpora  albicantia,  and  extending  forwards  to 
the  optic  tract.  From  its  centre  a  tubular  conical  process  of 
grey  matter,  the  infundibulum,  passes  downwards  and  forwards 
to  the  posterior  lobe  of  the  pituitary  body. 

The  pituitary  body  is  a  reddish-grey  vascular  mass  lying  in 
the  sella  turcica.  It  consists  of  two  lobes,  the  anterior  being 
the  larger. 

The  optic  commissure  or  chiasma  is  the  union  of  the  two 
optic  tracts,  and  is  placed  in  the  middle  line  just  in  front  of 
the  tuber  cinereum.  From  the  anterior  part  the  two  optic 
nerves  proceed. 

Decussation  of  the  nerve  fibres. — When  the  fibres  of  the  tract 
reach  the  commissure,  they  pass  across  for  the  most  part  to 
form  the  optic  nerve  of  the  opposite  side,  but  a  few  pass 
directly  into  the  nerve  of  the  same  side.  The  posterior  fibres 
of  the  chiasma  are  described  as  simply  passing  between  the 
two  inner  geniculate  bodies. 

The  lamina  cinerea  is  a  layer  of  grey  matter  lying  above 
the  optic  commissure,  and  passing  from  the  extremity  of  the 
corpus  callosum  backwards  to  the  tuber  cinereum  ;  laterally 
it  is  connected  with  the  grey  matter  of  the  anterior  perforated 
spot,  which  lies  under  the  anterior  end  of  the  corpus  callosum 
and  is  pierced  by  vessels. 

9 


(30  THE  POCKET  ANATOMY 

THE    CEREBRAL    HEMISPHERES. 

The  cerebral  hemispheres  form  as  a  whole  an  oval  mass, 
with  the  larger  end  backwards,  and  separated  into  two  equal 
portions  by  the  great  longitudinal  fissure.  Each  hemisphere 
presents  three  surfaces  : 

1.  Outer :  convex,  occupying  the  vault  of  the  cranium. 

2.  Inner :  flat,  forming  one  side  of  the  longitudinal  fissure. 

3.  Under:  irregular,  corresponding  in  shape  to  the  anterior 
and  middle  fossae,  and  to  the  upper  surface  of  the  tentorium. 
It  has  a  deep  cleft,  the  fissure  of  Sylvius,  between  the  portions 
occupying  the  anterior  and  middle  fossae. 

The  surface  of  each  hemisphere  consists  of  grey  matter, 
and  is  divided  into  convolutions  or  gyri  by  intervening  sulci. 

The  great  longitudinal  fissure  separates  incompletely  the 
two  hemispheres,  dividing  them  completely  in  front  and 
behind ;  but  at  the  base  near  the  middle  they  are  united  by 
the  corpus  callosum.  The  falx  cerebri  occupies  the  fissure. 

The  transverse  fissure  of  the  cerebrum  is  a  cleft  in  the 
posterior  part  of  the  brain,  which  is  seen  when  the  velum 
interpositum  and  choroid  plexuses  of  the  lateral  ventricles 
are  removed.  It  extends  from  the  tip  of  the  descending  cornu 
on  one  side,  over  the  optic  thalami,  3rd  ventricle,  and  mesen- 
cephalon  to  the  tip  of  the  descending  cornu  on  the  other  side. 

The  FISSURES  of  the  Hemispheres,  or  Interlobar  Sulci. 

1.  The  fissure  of  Sylvius  commences  below  at  the  outer 
side  of  the  anterior  perforated  spot,  passes  upwards  and  out- 
wards between  the  frontal  and  temporo-sphenoidal  lobes,  and 
divides  into  two  branches,  an  anterior  or  ascending,  the  shorter, 
passing  into  the  frontal  lobe,  and  a  posterior  or  horizontal, 
passing  behind  the  island  of  Reil,  upwards  and  backwards  to 
about  the  middle  of  the  outer  surface  of  the  hemisphere. 

2.  The  fissure  of  Rolando  commences  at  the  longitudinal 
fissure  near   the  vertex,   passes   downwards   and   forwards 
nearly  as  far  as   the  division  of  the  Sylvian  fissure.      It 
separates  the  parietal  and  frontal  lobes. 

3.  The  parieto-occipital  fissure  consists  of  two  portions,  an 
internal  or  perpendicular  fissure,  seen  on  the  inner  surface  of  the 
hemisphere,  and  an  external,  extending  on  the  outer  surface, 
between  the  parietal  and  occipital  lobes,  for  about  an  inch. 

4.  The  calloso-marginal  fissure  commences  in  front  near 
the  anterior  perforated  spot,  and  takes  a  course  on  the  inner 
surface  of  the  hemisphere  about  midway  between  the  corpus 
callosum  and  the  edge  of  the  longitudinal  fissure,  ending  a 
little  behind  the  upper  end  of  the  fissure  of  Rolando. 

5.  The  collateral  fissure  lies  along  the  lower  border  of  the 
uncinate  convolution ;   it   projects  inwards  and   forms  the 


THE  BRAIN  131 

eminentia  collateralis  in  the  descending  cornu  of  the  lateral 
ventricle. 

6.  Limiting  sulcus  of  Reil,  round  the  island  of  Reil  (p.  133). 

THE    LOBES. 

The   hemispheres   are  by   the  above   fissures  arbitrarily 
divided  into  seven  lobes,  viz. : — 

1.  Frontal:  limited  below  by  the  Sylvian  fissure,  behind  by 
the  fissure  of  Rolando,  internally  by  calloso-marginal  fissure. 

2.  Parietal:  limited  in  front  by  the  fissure  of  Rolando,  and 
behind  by  the  parieto-occipital  fissure ;  below  by  fissure  of 
Sylvius    continued    backwards,   and  internally  by   calloso- 
marginal  fissure. 

3.  Occipital:   Bounded  in   front    by   the   parieto-occipitai 
fissure ;  forms  the  posterior  part  of  the  hemisphere. 

4.  Temporo-sphenoidal :  occupies  middle  fossa  at  the  base  of 
the  skull,  being  placed  behind  the  Sylvian  fissure,  and  below 
the  parietal  and  occipital  lobes,  internally  separated  from 
limbic  lobe  by  collateral  fissure. 

5.  Central  or  Island  of  Reil:  contained  in  the  Sylvian  fissure ; 
triangular  in  shape. 

6.  Limbic  or  falciform:   consists  of  caliosal  and  uncinate 
gyri,  bounded  above  and  in  front  by  calloso-marginal  and 
below  by  collateral  fissures. 

7.  Olfactory :  lying  on  the  under  surface  of  the  frontal  lobe, 
sometimes  termed  the  olfactory  nerve. 

The  frontal  lobe  :— 
Convolutions  and  sidci  : — 
On  Tinder  surface : — 

The  tri-radiate  or  orbital  sulcus  divides  this  surface 
into  an  inner,  anterior,  and  posterior  or  outer  orbital 
convolutions.    On  the  inner  convolution  is  the  olfactory 
sulcus,  which  contains  the  olfactory  lobe. 
On  outer  surface : — 

The  ascending  frontal  or  precentral  convolution  is  bounded 
behind  by  the  fissure  of  Rolando,  round  the  lower  end 
of  which  it  joins  the  ascending  parietal  convolution ; 
in  front  by  the  precentral  sulcus. 

The  longitudinal  frontal  convolutions  are  three  in 
number,  upper,  middle,  and  inferior ;  they  occupy  the 
rest  of  the  outer  surface  and  are  separated  from  each 
other  by  two  sulci,  and  from  the  ascending  convolution 
by  the  precentral  sulcus. 
On  itmer  surface : — 

The  marginal  convolution  extends  along  the  edge  of  the 
longitudinal  fissure.  It  commences  at  the  anterior 

0—  7 


i32  THE  POCKET  ANATOMY 

perforated  spot,  and  is  limited  below  by  the  calloso- 
marginal  sulcus,  and  behind  by  its  upturned  extremity . 

2.  The  parietal  lohe  : — 

Convolutions  and  sulci : — 
On  outer  surface : — 

The  intra- parietal  sulcus  commences  near  posterior 
limb  of  Sylvian  fissure,  passes  upwards  parallel  to  the 
lower  ha'f  of  the  fissure  of  Rolando,  and  then  turns 
backwards  to  end  near  parieto-occipital  fissure. 

The  postcentral  stilcus  continues  the  line  of  the  vertical 
part  of  the  intra-parietal  sulcus. 

The  ascending  parietal  convolution  is  bounded  in  front 
by  the  fissure  of  Rolando,  behind  by  the  intra-parietal 
and  postcentral  fissures,  below  by  the  fissure  of  Sylvius, 
and  above  it  joins  the  superior  parietal  convolution. 

The  superior  parietal  convolution  is  bounded  by  the  post- 
central  fissure  in  front,  behind  by  the  parieto-occipital 
fissure,  round  which  it  is  connected  to  the  superior 
occipital  convolution  by  the  first  anncctant  gyrus. 

Inferior  parietal  subdivided  into : — 

The  supra-marginal  convolution,  bounded  in  front  and 
above  by  the  intra-parietal  fissure,  round  the  lower 
end  of  which  it  joins  the  ascending  parietal  convolu- 
tion ;  behind  by  the  posterior  limb  of  the  Sylvian 
fissure,  round  which  it  joins  the  superior  temporo- 
sphenoidal  convolution. 

The  angular  convolution  occupies  the  rest  of  the  outer 
surface  of  the  parietal  lobe.  Above  is  the  superior 
parietal  lobule,  below  the  temporo-sphenoidal  lobe,  in 
front  the  supra-marginal  gyrus,  and  behind  the  occipital 
lobe :  it  arches  over  the  upturned  end  of  the  parallel 
sulcus,  and  is  continuous  with  the  second  temporo- 
sphenoidal  convolution.  The  postparietal  convolution 
curves  over  the  upturned  second  temporal  sulcus,  and 
is  continued  into  the  third  temporo-sphenoidal  con- 
volution. 
On  the  inner  surface : — 

The  quadrate  lobule  lies  anterior  to  the  cuneate  ;  it  is 
bounded  behind  by  the  internal  parieto-occipital  fissure, 
and  in  front  by  the  ascending  terminal  limb  of  the 
calloso-marginal  sulcus. 

3.  The  occipital  lobe  : — 

On  outer  surface  three  convolutions,  an  upper,  a  middle,  and 
an  inferior,  by  two  sulci. 

The  superior  occipital  convolution  is  connected  anteriorly  to 
the  6-H.perior  parietal  lobule  by  the  first  annectant  gyrus. 


THE  BRAIN  133 

The  middle  occipital  convolution  joins  the  angular  convolution 
by  the  second  annectant  gyms,  and  to  the  middle  temporo- 
sphenoidal  convolution  by  the  third  annectant  gyrus. 

The  inferior  occipital  convolution  is  connected  to  the  inferior 
temporo  -  sphenoidal  convolution  by  the  fourth  annectant 
gyrus. 

On  inner  surface : — 

The  cuneate  lobule  is  the  area  between  the  internal  parieto- 
occipital  and  the  calcarine  fissures. 

The  calcarine  fissure  commences  at  the  posterior  part  of  the 
inner  surface  of  the  occipital  lobe  by  a  forked  extremity ;  is 
joined  about  half-way  by  the  internal  parieto-occipital  fissure, 
and  ends  near  the  posterior  extremity  of  the  corpus  callosum. 

On  under  surface : — 

The  inferior  occipito-temporal  convolution  lies  just  below  the 
collateral  fissure,  and  extends  from  the  apex  of  the  temporo- 
sphenoidal  lobe  to  the  posterior  part  of  the  hemisphere,  form- 
ing the  under  surface  of  both  temporal  and  occipital  lobes. 

4.  The  temporo-sphenoidal  lobe  : — 
On  outer  surface  : — 

The  superior  temporo-sphenoidal  or  parallel  sulcus  runs  parallel 
to  posterior  limb  of  the  Sylvian  fissure. 

The  middle  temporo  -  sphenoidal  sulcus  lies  parallel  to  the 
superior. 

The  superior  temporo-sphenoidal  convolution  (infra-marginal)  is 
bounded  above  by  posterior  limb  of  Sylvian  fissure,  and  con- 
tinuous behind  with  supra-marginal  convolution. 

The  middle  temporo-sphenoidal  convolution  joins  posteriorly 
the  angular,  and  by  the  third  annectant  gyrus  merges  into 
the  middle  occipital  convolution. 

The  inferior  temporo-sphenoidal  convolution  joins  the  inferior 
occipital  convolution  by  the  fourth  annectant  gyrus. 

On  under  surface  : — 

Inferior  occipito-temporal  convolution  in  its  anterior  part. 

5.  The  central  lobe  or  island  of  Reil  lies  in  the  fissure  of 
Sylvius  at  the  base  of  the  brain.     Boundaries  :  In  front,  the 
anterior  sulcus  of  Reil,  which  separates  it  from  the  posterior 
orbital  convolution.     Superiorly,  the  superior  sulcus  of  Reil, 
separating  it  from  the  gyri  of  the  operculum,  a  collective 
name  given  to  the  portions  of  the  inferior  frontal,  and  lower 
ends  of  the  ascending  frontal  and  parietal  convolutions  which 
lie  between  the  ascending  and  posterior  limbs  of  the  Sylvian 
fissure.    Posteriorly,  by  the  posterior  sulcus  of  Reil,  separating 
it  from  the  temporo-sphenoidal  lobe.     It  is  divided  by  the 
central  sulcus  into  an  anterior  part,  which  is  subdivided  into 


I34  THE  POCKET  ANATOMY 

three  gyri  breves,  and  a  posterior  part  subdivided  into  two 
gyri  longi. 

6.  The  limbic  lobe  : 

On  the  inner  surface  consists  of : — 

The  gyrus  fornicatus  or  callosal  convolution  lies  beneath  the 
marginal  convolution,  being  separated  from  it  by  the  calloso- 
marginal  sulcus.  It  commences  near  the  anterior  perforated 
spot,  follows  the  curves  of  the  corpus  callosum,  near  the 
posterior  end  of  which  it  becomes  continuous  with  the 
uncinate  gyrus. 

The  uncinate  convolution  (hippocampal)  commences  below 
the  splenium  of  the  corpus  callosum ;  here  the  end  of  the 
calcarine  fissure  cuts  into  it,  leaving  a  narrow  isthmus  con- 
necting it  with  the  callosal  convolution.  It  runs  forwards 
above  the  collateral  fissure  into  the  temporal  lobe  and  ends 
as  the  uncus. 

The  dentate  sulcus  (hippocampal)  lies  along  the  upper  border 
of  the  uncinate  convolution,  and  forms  the  hippocampus 
major  in  the  descending  cornu  of  the  lateral  ventricle. 

The  dentate  convolution  (fascia  dentata)  lies  in  the  dentate 
fissure,  It  is  formed  by  the  superficial  grey  matter  of  the 
hemisphere,  which  here  ends  in  a  fringed  margin. 

7.  The  olfactory  lobe  extends  from  the  anterior  perforated 
spot  as  the  olfactory  tract,  and  ends  in  an  enlargement,  the 
olfactory  bulb.     It  lies  in  the  olfactory  sulcus  on  the  orbital 
surface  of  the  frontal  lobe.     Posteriorly  the  tract  bifurcates, 
the  outer  root   passing   across   commencement   of   Sylvian 
fissure  to  the  uncinate  convolution,  and  the  inner  one  to  the 
great  longitudinal  fissure  to  join  the  callosal  convolution. 

THE  INTERIOR  OF  THE  CEREBRUM. 

The  centrum  ovale  minus  is  the  central  white  mass  in  each 
hemisphere  seen  on  horizontal  section,  the  section  being  made 
about  £  inch  above  the  corpus  callosum. 

The  centrum  ovale  majus,  seen  on  section  at  the  level  of 
the  corpus  callosum,  is  the  centrum  ovale  minus  of  each  side, 
joined  by  the  corpus  callosum. 

The  corpus  callosum  lies  at  the  bottom  of  the  great  longi- 
tudinal fissure.  It  is  the  great  transverse  commissure  of  the 
hemispheres,  and  consists  principally  of  transverse  fibres. 

Length. — About  4  inches,  extending  to  within  i£  inches  of 
the  anterior,  and  2$  inches  of  the  posterior  extremities  of  the 
hemispheres. 

Shape. — Broader  behind  than  in  front,  thicker  at  each  end 


THE  BRAIN  135 

than  at  the  middle,  and  thickest  behind.  It  terminates  pos- 
teriorly in  a  free,  thickened  border,  the  splenium ;  in  front  it 
curves  down  towards  the  base  of  the  brain,  the  bend  being 
known  as  the  genu,  and  the  reflected  part  as  the  rostrum. 

Raphe :  the  longitudinal  eminence  along  the  centre  of  the 
upper  surface. 

Nerves  of  Lancisi  (striae  longitudinales) :  longitudinal  white 
fibres  placed  on  each  side  of  the  raphe. 

Covered  band  of  Reil :  longitudinal  fibres  outside  the  nerves 
of  Lancisi,  under  cover  of  the  convolution  of  the  corpus 
callosum. 

Relations. — Upper  surface  forms  floor  of  great  longitudinal 
fissure ;  under  surface  connected  behind  with  the  fornix,  and 
in  front  of  this  with  the  septum  lucidum.  The  extremity  of  the 
rostrum  is  connected  centrally  with  the  lamina  cinerea,  and 
laterally  with  two  white  bands,  the  peduncles  of  the  corpus 
callosum,  which  pass  backwards  and  outwards  over  the  anterior 
perforated  spot  towards  the  Sylvian  fissure  to  the  anterior 
extremity  of  the  temporal  lobes.  Traced  upwards,  these 
fibres  are  continuous  with  nerves  of  Lancisi  The  corpus 
callosum  roofs  in  the  bodies  and  anterior  cornua  of  the  lateral 
ventricles. 

The  lateral  ventricles  are  two  in  number,  one  in  each 
hemisphere.  They  communicate  below  and  in  front  with 
one  another  and  with  the  3rd  ventricle  by  the  foramen  of 
Munro.  Each  ventricle  consists  of  a  body  or  central  cavity, 
and  three  cornua,  anterior,  posterior,  and  descending. 

Relations  of  the  body : — 
Roof. — Corpus  callosum. 

Internal  wall. — Septum  lucidum  and  the  fornix. 
Floor. — From  before  backwards. 

1.  Caudate  nucleus  of  corpus  striatum. 

2.  Tasnia  semicircularis. 

3.  Part  of  optic  thalamus  in  front  of  choroid  plexus. 

4.  Choroid  plexus  of  lateral  ventricle. 

5.  Fimbriated  edge  of  the  fornix. 

The  anterior  cornu  is  the  anterior  end  of  the  ventricle  which 
curves  outwards  round  the  caudate  nucleus. 
Relations : — 

In Front.  Roof.  Floor  and  Externally.      Internally 

Genu  of  corpus        Corpus  callosum.          Caudate  nucleus.          Septum  1« 
callosum.  dum. 

The  posterior  cornu  projects  backwards  and  inwards  into  tfc 
occipital  lobe. 


'36 

THE  POCKET  ANATOMY 

Relations  :  — 

Roof  and  Outer 
Wall. 

Floor. 

Inner  Wall. 

At  Junction  o/ 
Posterior  and  De* 

scending  Cornua. 

Fibres  of  corpus 
callosum  pass- 
ing to  temporo- 
sph  eno  id  al 

White  substance 
of  occipital 
lobe. 

Hippocam- 
pus minor, 
formed  by 
the  calcar- 

Eminentia   collater- 
alis,     formed     by 
the    inward     pro- 
jection of  the  col- 

lobe. 

ine  sulcus, 

lateral  sulcus. 

projecting 
inwards. 

The  descending  cornu  passes  at  first  backwards  and  outwards 
round  the  posterior  part  of  the  optic  thalamus,  then  down- 
wards, forwards  and  inwards. 

Relations : — 

Roof.  Floor.  Inner  Wall.          Outer  Wall. 

Fibres   of  corpus      Hippocampus      Pia  mater.          White  substance 

callosum     pass-          major.  of    the     hemi- 

ing  to  temporo-      Tzenia  hippocampi.  sphere. 

sphenoidal  lobe.      Choroid  plexus. 
Amygdaloid      tu-      Eminentia    collator- 

bercle.  alis. 

Tail    of    caudate 

nucleus. 

The  hippocampus  major  :  a  large  white  projection  in  the 
whole  length  of  the  floor  of  the  descending  cornu.  It  corre- 
sponds with  the  dentate  sulcus.  The  anterior  extremity 
becomes  enlarged  and  indentated,  forming  the  pes  hippocampi. 

Tcenia  hippocampi  or  fimbria  of  the  fornix :  a  narrow  white 
band  prolonged  from  the  posterior  pillar  of  the  fornix,  and 
lying  along  the  inner  margin  of  the  hippocampus  major. 

The  septum  lucidum  is  a  double  vertical  partition  between 
the  lateral  ventricles,  attached  to  the  fornix  and  rostrum  below, 
and  to  the  under  surface  of  the  body  of  the  corpus  callosum 
above.  Between  the  layers  is  the  5th  ventricle,  a  closed 
narrow  space,  having  no  connection  with  the  other  ventricles, 
and  not  lined  by  ependyma. 

The  fornix  consists  of  two  white  longitudinal  strata  beneath 
the  corpus  callosum,  separated  in  front  and  behind,  forming 
the  pillars,  but  joined  in  the  middle,  forming  the  body. 

The  body  is  triangular  in  shape,  the  base  being  placed  pos- 
teriorly, and  here  connected  with  the  corpus  callosum.  In 
front  of  this  it  is  connected  with  the  septum  lucidum  along  its 
upper  surface.  The  lateral  margins  are  free,  lying  against  the 
choroid  plexus  of  the  lateral  ventricles.  The  under  surface 
lies  upon  the  velum  interpositum. 

The  anterior  pillars  pass  downwards,  forming  the  anterior 


THE  BRAIN  137 

boundary  of  the  foramen  of  Monro,  then  through  the  grey 
matter  on  the  outer  side  of  the  3rd  ventricle ;  and  on  reaching 
the  base  of  the  brain  they  make  a  half  figure-of-eight  turn, 
forming  the  white  envelope  of  the  corpora  albicantia ;  they 
then  ascend  and  pass  into  the  anterior  nucleus  of  the  optic 
thalamus.  The  pillars  receive  near  the  foramen  of  Monro 
the  fibres  of  the  peduncles  of  the  pineal  gland,  and  those  of 
the  taenia  semicircularis. 

The  posterior  pillars :  the  two  strata  of  the  fornix  diverge 
behind,  being  connected  at  first  with  the  splenium  of  the 
corpus  callosum  ;  thence  curving  round  the  pulvinar  they 
pass  into  the  descending  cornu,  the  outer  fibres  being  lost  on 
the  hippocampus  major,  the  inner  ones  forming  the  taenia 
hippocampi. 

Between  the  diverging  posterior  pillars  a  portion  of  the 
splenium  with  transverse  markings  is  exposed  ;  this  is  known 
as  the  lyra . 

The  foramen  of  Monro  is  the  interval  between  the  anterior 
pillars  of  the  fornix  and  the  optic  thalami.  It  is  Y-shaped, 
the  two  limbs  anteriorly  communicating  with  the  lateral 
ventricles  on  either  side,  and  the  junction  of  the  two  opening 
into  the  3rd  ventricle. 

The  velum  interposition  is  a  triangular  process  of  pia  mater 
prolonged  through  the  transverse  fissure  and  lying  over  the 
3rd  ventricle  and  upper  surfaces  of  the  optic  thalami.  Its 
apex  reaches  the  foramen  of  Monro,  and  the  fornix  lies  upon 
its  upper  surface. 

Choroid  plexuses : — 

Of  the  lateral  ventricles  are  fringed  vascular  processes  extend- 
ing from  the  foramen  of  Monro  to  commencement  of  descend- 
ing cornu,  and  attached  along  the  lateral  margins  of  the 
velum  interpositum ;  thence  each  passes  into  the  descending 
cornu,  resting  on  the  taenia  hippocampi  and  hippocampus 
major,  forming  the  choroid  plexus  of  the  descending  cornu. 

Of  the  yd,  ventricle:  from  the  under  surface  of  the  velum 
interpositum  there  depend  two  vascular  fringes,  diverging 
behind,  and  forming  the  choroid  plexus  of  3rd  ventricle. 

Veins  of  Galen :  two  veins  formed  by  junction  of  the  vein 
of  the  corpus  striatum  and  choroidal  vein  of  each  side,  and 
running  backwards  between  the  layers  of  the  velum  inter- 
positum, and  uniting  posteriorly  into  one  trunk,  which  opens 
into  the  straight  sinus. 

The  corpora  striata,  so  called  from  their  appearance  on 
section,  which  displays  alternate  white  and  grey  bands,  are 
two  in  number,  one  in  each  hemisphere,  and  are  sometimes 
termed  the  ganglia  of  the  hemisphere.  Each  consists  of  an 


138  THE  POCKET  ANATOMY 

ovoid  mass  of  grey  matter  lying  outside  and  in  front  of  the 
optic  thalamus.  The  largesfpart  (lenticular  nucleus)  lies  in  the 
white  matter  of  the  hemisphere  outside  the  lateral  ventricle, 
and  a  smaller  part  (caudate  nucleus)  appears  in  the  floor  of  that 
space. 

The  caudate  nucleus  is  pear-shaped,  with  the  larger  end 
placed  anteriorly,  occupying  the  floor  and  outer  wall  of  the 
anterior  cornu ;  the  narrow  posterior  part  lying  along  the  floor 
and  outer  wall  of  the  lateral  ventricle  passes  into  the  roof  of 
the  descending  cornu,  where  it  is  joined  by  the  taenia  semi- 
circularis  to  form  the  amygdaloid  tubercle. 

The  lenticular  nucleus  lies  outside  and  at  a  lower  level  than 
the  caudate  nucleus,  from  which  it  is  separated  by  a  layer 
of  white  fibres,  the  internal  capsule.  Outside  the  nucleus  is 
another  stratum  of  white  fibres,  the  external  capsule,  and 
beyond  this  a  thin  lamina  of  grey  matter  called  the  claustrum, 
the  outer  surface  of  which  lies  next  to  the  white  substance  of 
the  island  of  Reil. 

The  taenia  semicircularis  is  a  narrow  band  of  white  fibres 
attached  to  the  anterior  pillar  of  the  fornix  in  front,  whence  it 
passes  backwards  in  the  floor  of  the  lateral  ventricle,  between 
the  caudate  nucleus  and  the  optic  thalamus ;  it  then  passes 
into  the  roof  of  the  descending  cornu,  at  the  end  of  which  it 
enters  a  mass  of  grey  matter,  the  nucleus  amygdala,  continuous 
with  the  superficial  grey  matter  at  the  apex  of  the  temporo- 
sphenoidal  lobe,  and  placed  just  under  the  lenticular  nucleus. 

The  anterior  commissure  is  a  bundle  of  white  fibres  lying  in 
the  anterior  part  of  the  3rd  ventricle,  in  front  of  the  anterior 
pillars  of  the  fornix.  The  fibres  go  through  the  caudate 
nucleus,  and,  passing  under  the  lenticular  nucleus,  ultimately 
enter  the  temporo-sphenoidal  lobe. 

SYNOPSIS   OF   COURSE   OF  FIBRES   IN   THE   CENTRAL 
HEMISPHERES. 

i .  Peduncular  fibres,  connecting  cord  and  cerebellum  with 
cerebrum : — 

(a)  From  crusta,  chiefly  through  internal  capsule   to 

convolutions. 

(b)  From  tegmentum,  chiefly  to  optic  thalamus ;  a  part 

joins  the  inner  capsule,  and  passes  to  occipital 

and  temporo-sphenoidal  lobes. 

The  peduncular  fibres,  in  their  course  to  the  convolutions, 
are  reinforced  by  fibres  from  the  corpora  striata  and  optic 
thalami. 


THE  BRAIN  139 

2.  Transverse  fibres,  connecting  the  two  hemispheres  : — 

(a)  Of  corpus  callosum. 

(b)  Anterior  commissure. 

3.  Collateral  fibres,  connecting  different  parts  of  the  same 
hemisphere. 

(a)  Fornix. 

(b)  Ttenia  semicircularis. 

(c)  Nerves  of  Lancisi. 

(d)  Gyrus  fornicatus,  the  fibres  of  which  are  said  to 

encircle  the  corpus  callosum,  near  the  middle 
line,  meeting  at  the  anterior  perforated  space. 

(e)  Uncinate  fasciculus,  a  white  bundle  at  the  bottom 

of  the  Sylvian  fissure,  uniting  the  frontal  and 

temporo-sphenoidal  lobes. 
(/)  Inferior  longitudinal  fasciculus,  a  collection  of  fibres 

passing  between  temporo-sphenoidal  and  occipital 

lobes. 
(g)  Association  fibres,  passing  between  and  connecting 

together  the  different  convolutions. 

THE    MEMBRANES   OF   THE    BRAIN,    OR   MENINGES. 

The  DURA  MATER,  the  most  external,  is  a  dense  fibrous 
membrane,  which  is  closely  attached  to  the  bones  of  the 
skull,  forming  their  internal  periosteum.  The  inner  surface  is 
smooth,  and  covered  with  endothelium.  It  is  continuous  with 
the  dura  mater  of  the  spinal  cord  through  the  foramen  magnum. 
The  fibrous  part  of  the  dura  mater  is  divided  into  two  layers, 
an  outer,  forming  the  periosteum,  and  an  inner,  lying  under 
the  endothelium,  forming  certain  processes,  and  which,  by  its 
separation  in  certain  situations,  forms  the  sinuses  (for  sinuses 
of  dura  mater,  vide  p.  97).  On  the  upper  surface,  near,  and 
projecting  into  the  longitudinal  sinus,  are  the  Pacchionian 
bodies,  which  are  enlarged  villi  of  the  arachnoid  projecting 
through  the  layers  of  dura  mater. 

Processes  of  the  dura  mater : — 

The  falx  cerebri  :  placed  vertically  between  the  two  hemi- 
spheres of  the  cerebrum,  attached  in  front  to  the  crista  galli, 
behind  to  the  upper  surface  of  the  tentorium,  and  between 
these  above  to  middle  line  of  internal  surface  of  skull,  while 
the  lower  border  is  concave  and  free.  In  relation  with  it  are 
the  superior  and  inferior  longitudinal,  and  the  straight  sinuses. 

The  tentorium  cerebelli  is  a  crescentic  fold  of  dura  mater 
placed  between  the  cerebrum  and  the  cerebellum.  It  has  an 
outer  convex  border,  by  which  it  is  attached  in  front  to  the 


140  THE  POCKET  ANATOMY 

posterior  clinoid  processes,  superior  edge  of  the  petrous  bone, 
and  behind  to  the  margins  of  the  groove  for  the  lateral  sinus. 
The  inner  concave  border  is  free  posteriorly,  and  forms  the 
opening  through  which  the  crura  cerebri  and  the  posterior 
cerebral  arteries  pass  from  the  posterior  into  the  middle  cranial 
fossa ;  in  front  this  border  passes  over  the  attached  border,  and 
is  attached  to  the  anterior  clinoid  processes.  The  tentorium 
is  a  tent-like  process,  highest  above  and  in  front,  at  its  most 
anterior  point  of  attachment  of  the  falx  cerebri  by  which  the 
tentorium  is  suspended,  and  from  this  point  descending  on  all 
sides.  In  relation  to  it  are  the  lateral,  superior  petrosal,  and 
straight  sinuses. 

The  falx  cerebelli  reaches  vertically  from  the  tentorium 
to  the  foramen  magnum,  dividing  the  two  hemispheres  of 
the  cerebellum.  It  is  attached  posteriorly  to  the  vertical 
crest  of  the  occiput,  where  it  encloses  the  occipital  sinus,  and 
below  to  each  side  of  the  foramen  magnum. 

The  PIA  MATER  consists  of  a  delicate  stroma  supporting 
bloodvessels,  and  closely  invests  the  brain,  dipping  into  the 
sulci.  At  the  transverse  fissure  it  is  prolonged  into  the  lateral 
ventricles  and  over  the  3rd  ventricle,  pushing  the  endothelial 
lining  of  those  cavities  in  front  of  it,  and  forming  the  velum 
interpositum  and  choroid  plexuses  of  the  lateral  and  3rd  ven- 
tricles. It  is  prolonged  over  the  roof  of  the  4th  ventricle, 
sending  inwards  two  vascular  fringes,  the  choroid  plexuses  of 
that  cavity. 

The  ARACHNOID  is  a  thin  membrane  lying  outside  the 
pia  mater,  but  is  not  so  closely  applied  to  the  brain,  as  it 
passes  over  the  sulci  without  dipping  into  them.  Between 
the  pia  mater  and  the  arachnoid  is  the  subarachnoid  space, 
containing  the  subarachnoid  fluid.  The  space  between  the 
dura  mater  and  arachnoid  is  now  known  as  the  subdural 
space. 

The  subarachnoid  space  is  larger  in  some  places  than  in 
others.  The  arachnoid  stretches  across  between  the  two 
middle  lobes  at  the  base  of  the  brain,  forming  the  cisterna 
basalis,  which  lies  anterior  to  the  pons  and  reaches  as  far 
forward  as  the  optic  nerves.  Beneath  the  cerebellum  it  forms 
in  a  like  manner  the  cisterna  magna,  by  stretching  between 
the  under  surface  of  the  cerebellum  and  the  posterior  surface 
of  the  medulla. 

At  the  bottom  of  the  longitudinal  fissure  the  subarachnoid 
space  is  also  large. 

The  subarachnoid  space  communicates  with  the  cerebral 
ventricles  by  the  foramen  of  Majendie,  an  opening  into  the 


NERVES  141 

4th  ventricle  in  the  expansion  of  pia  mater  across  the  roof. 
There  are  two  other  openings  through  the  pia  mater,  placed 
one  on  each  side  of  the  upper  roots  of  the  glosso-pharyngeal 
nerve,  under  the  flocculus. 


THE  NERVES. 

THE  NERVES  OF  THE  HEAD  AND  NECK. 

THE    CRANIAL    NERVES,   12  pairs. 

IST  or  OLFACTORY.  Course:  the  olfactory  tract  passes 
forwards  on  the  under  surface  of  the  frontal  lobe  near  the 
longitudinal  fissure,  resting  on  cribriform  plate  and  expanding 
anteriorly  into  olfactory  bulb.  There  is  an  enlargement  at  the 
posterior  part  of  the  upper  surface  called  the  olfactory  tubercle. 

Distribution. — About  twenty  nerve  filaments  are  given  off 
from  under  surface  of  the  olfactory  bulb  (p.  134),  and  pass 
downwards  through  ethmoidal  foramina;  they  are  divided 
into  three  sets  to  supply  Schneiderian  membrane  of  the  nose  ; 
inner  to  septum,  middle  to  roof  of  nose,  outer  to  superior  and 
middle  turbinate  bones. 

Special  function. — Smelling. 

2ND  or  OPTIC.  Origin,  from  optic  tract,  which  arises  by  two 
roots :  Outer,  from  external  geniculate  body,  optic  thalamus 
and  brachium  of  superior  quadrigeminal  body.  Inner,  from 
internal  geniculate  body. 

Course. — Winds  across  outer  and  anterior  surfaces  of  crus 
cerebri,  uniting  with  fellow  to  form  optic  commissure,  which 
is  bounded  in  front  by  the  lamina  cinerea  and  behind  by  the 
tuber  cmereum  ;  the  nerves  separate  at  fore  part  of  commis- 
sure, get  ensheathed  in  arachnoid,  and  pass  into  orbit  through 
optic  foramen  above  and  internal  to  ophthalmic  artery ;  whilst 
passing  through,  each  receives  a  tube  of  dura  mater,  which 
divides  into  two,  the  outer  piece  becoming  orbital  periosteum, 
and  the  inner,  ensheathing  the  nerve,  joins  the  sclerotic 
in  front.  The  nerve  pierces  sclerotic  and  choroid  coats  of 
eyeball. 

Distribution. — Expands  to  form  innermost  layer  of  retina. 

Special  function. — Nerve  of  sight. 

3RD  or  MOTOR  OCULI.  Superficial  origin  :  inner  side  of  crus 
cerebri,  just  in  front  of  pons.  Deep  origin  :  floor  of  aqueduct 
of  Sylvius. 

Course. — Pierces  dura  mater  to  enter  canal  in  outer  wall  of 


i4«  THE  POCKET  ANATOMY 

cavernous  sinus  near  posterior  clinoid  process,  lying  above 
and  internal  to  4th  nerve.  As  it  passes  forwards  to  enter 
orbit  through  sphenoidal  fissure,  the  4th  nerve  and  frontal 
branch  of  5th  cross  externally  and  become  superior  to  it.  It 
divides  into  two  branches  in  the  fissure,  which  enter  orbit 
between  the  heads  of  the  external  rectus,  the  nasal  branch  of 
the  5th  lying  between  the  two ;  whilst  in  cavernous  sinus  it 
communicates  with  cavernous  plexus. 

Distribution. — Superior  branch  supplies  superior  rectus  and 
levator  palpebrae  superioris.  Inferior  divides  into  three,  for 
internal  rectus,  for  inferior  rectus,  and  for  inferior  oblique, 
which  latter  gives  off  short  or  motor  root  to  the  lenticular 
ganglion,  through  which  the  3rd  nerve  supplies  the  ciliary 
muscle  and  the  sphincter  fibres  of  the  iris. 

Special  function. — Motor  nerve  of  eyeball. 

4TH  or  TROCHLEAR.  Origin — Superficial :  valve  of  Vieussens, 
just  behind  corpora  quadrigemina.  Deep :  floor  of  aqueduct 
of  Sylvius. 

Course. — Winds  round  outer  surface  of  crus  cerebri  and 
pierces  free  border  of  tentorium  ;  passes  forwards  in  outer 
wall  of  cavernous  sinus  below  3rd,  but  enters  orbit  through 
sphenoidal  fissure  above  and  internal  to  the  other  nerves  and 
external  rectus. 

Distribution. — Enters  orbital  surface  of  superior  oblique. 

Special  function. — Motor  nerve  of  superior  oblique. 

5TH  or  TRIFACIAL.  Origin — Superficial :  from  the  side  of 
the  pons,  by  small  motor  and  large  sensory  roots,  the  latter 
having  a  ganglion  on  it.  Deep :  Sensory :  (a)  floor  of  4th 
ventricle  ;  (6)  (ascending  root),  posterior  horn  of  grey  matter 
of  medulla,  and  upper  part  of  cord.  Motor:  (a]  floor  of  4th 
ventricle  ;  (b)  (descending  root),  side  of  aqueduct  of  Sylvius. 

Course. — The  two  roots  pass  forwards  through  oval  opening 
in  dura  mater  near  apex  of  petrous  bone,  the  sensory  root 
entering  the  Gasserian  ganglion,  lodged  on  the  apex  of  petrous 
part  of  temporal  bone.  The  motor  root  passes  under  ganglion 
and  is  not  connected  with  it,  but  goes  through  foramen  ovale 
uniting  with  the  Inferior  Maxillary  division. 

The  Gasserian  ganglion :  lodged  in  a  depression  (Meckel's 
cave)  near  the  apex  of  petrous  part  of  temporal,  gives  off  from 
its  anterior  edge  the  ophthalmic,  superior  maxillary,  and  inferior 
maxillary  trunks.  The  two  former  are  purely  sensory  ;  the 
last  by  joining  small  motor  root  becomes  a  mixed  nerve. 

OPHTHALMIC  or  ist  division  of  the  5th  (sensory  and  smallest 
branch)  :  courses  along  outer  wall  of  cavernous  sinus  below 
3rd  and  4th  nerves,  to  enter  orbit  through  sphenoidal  fissure. 


NERVES  143 

In  sinus  communicates  with  cavernous  plexus  and  third, 
fourth,  and  sixth  nerves,  and  divides  into  three  branches, 
two  of  which,  frontal  and  lachrymal,  enter  orbit  above 
external  rectus,  whilst  the  third  or  nasal  passes  between  two 
heads  of  origin  of  that  muscle,  and  between  two  divisions  of 
3rd  nerve. 

Branches : — 

Lachrymal :  passes  along  outer  wall  of  orbit  to  under  sur- 
face of  lachrymal  gland,  communicates  with  orbital  of 
superior  maxillary,  finally  pierces  palpebral  fascia,  and  sup- 
plies skin  of  upper  eyelid,  inosculating  with  branches  of  facial. 

Frontal :  largest  branch,  enters  orbit  just  outside  4th  nerve, 
passes  forward  on  levator  palpebrae,  and  divides  into  : — 

Supra -trochlear :  directed  forwards  and  inwards  between 
pulley  and  supra-orbital  notch ;  distributed  to  forehead  and 
communicates  with  infra-trochlear. 

Supra-orbital :  continuation  of  frontal,  passes  through  notch, 
supplies  palpebral  filaments,  and  ends  on  forehead  by  dividing 
just  outside  orbit  into  two  branches,  of  which  the  external  is 
the  larger.  It  supplies  the  scalp.  Communicates  with  facial. 

Nasal :  enters  orbit  between  the  heads  of  the  external 
rectus,  passes  forwards  and  inwards  over  optic  nerve  along 
inner  side  of  orbit,  through  anterior  ethmoidal  foramen ; 
re-entering  cranium,  it  passes  down  nasal  slit  by  the  side  of 
the  crista  galli,  dividing  into  two  terminal  branches,  viz : — 

Internal :  supplying  mucous  membrane  of  the  septum. 

External :  runs  along  groove  on  internal  surface  of  nasal 
bone,  then  passes  between  bone  and  lateral  cartilage  to 
supply  skin  of  ala,  and  tip  of  nose.  Communicates  with 
facial. 

Branches  from  nasal  in  the  orbit : — 

Ganglionic :  arises  between  heads  of  external  rectus,  passes 
along  outer  side  of  optic  nerve,  entering  the  posterior  superior 
angle  of  lenticular  ganglion,  of  which  it  forms  the  long  or 
sensory  root. 

Long  ciliary  (2  or  3)  pass  along  inner  side  of  optic  nerve, 
join  some  short  ciliary  branches  from  ganglion,  and,  piercing 
sclerotic,  are  distributed  to  ciliary  body  and  iris. 

Infra-trochlear  :  given  off  as  nerve  enters  anterior  ethmoidal 
foramen  ;  it  passes  to  inner  angle  of  orbit,  communicating 
beneath  '  pulley  '  with  the  supra- trochlear  of  frontal.  It  sup- 
plies lachrymal  sac,  skin  of  eyelids  and  root  of  nose. 

The  LENTICULAR  GANGLION  is  a  small  reddish-coloured 
body,  placed  between  the  optic  nerve  and  the  external  rectus, 
•at  the  back  part  of  the  orbit. 


»44  THE  POCKET  ANATOMY 

Branches  of  communication  or  roots : — 

Long  or  sensory  root :  from  the  nasal  of  the  ophthalmic,  joins 
posterior  superior  angle. 

Short  or  motor  root :  from  the  branch  of  the  3rd  nerve  sup- 
plying inferior  oblique,  joins  posterior  inferior  angle. 

Sympathetic :  from  the  cavernous  plexus,  and  frequently 
joined  with  the  long  or  sensory  root. 

Branches  of  distribution : — 

Short  Ciliary  Nerves  :  Ten  or  twelve  given  off  in  two  bundles, 
large  inferior  and  small  superior.  Pass  forwards  above  and 
below  optic  nerve,  with  long  ciliary  of  nasal.  The  branches 
subdivide  and,  piercing  sclerotic,  run  in  grooves  on  its  internal 
surface  10  end  in  ciliary  muscle  and  iris.  The  circular  fibres 
of  the  iris  and  the  ciliary  muscle  are  innervated  by  the  third 
nerve,  the  radial  fibres  of  the  iris  by  the  sympathetic. 

The  SUPERIOR  MAXILLARY  NERVE  (sensory)  passes  from  the 
middle  of  the  Gasserian  ganglion  through  foramen  rotundum, 
then  across  spheno-maxillary  fossa  to  enter  the  infra-orbital 
canal,  and  here  receives  the  name  of  infra- orbital.  Emerging 
on  the  face  from  the  infra-orbital  foramen  under  the  levator 
labii  superioris,  it  divides  into  a  number  of  branches,  nasal, 
palpebral  and  labial,  and  joins  with  branches  of  the  facial 
nerve  to  form  the  infra-orbital  plexus. 

Branch  in  the  Skull : — 

Recurrent :  given  off  near  origin  to  dura  mater. 

Branches  given  of  in  the  Spheno -maxillary  fossa  : — 

Orbital  ortemporo-malar:  enters  orbit  by  spheno-maxillary 
fissure  and  directly  divides  into  : — 

Temporal:  passes  along  groove  in  oufer  wall  of  orbit,  here 
communicating  with  the  lachrymal  :  it  then  goes  through 
a  foramen  in  the  malar  bone,  and,  entering  the  temporal 
fossa,  passes  anterior  to  the  temporal  muscle  :  piercing  the 
temporal  aponeurosis,  it  becomes  cutaneous,  and  inosculates 
with  branches  from  the  facial  nerve. 

Malar:  passes  to  lower  and  outer  angle  of  orbit,  goes 
through  malar  foramen,  and  communicating  with  the  facial 
becomes  cutaneous. 

Spheno-palatine  (2)  descend  to  Meckel's  ganglion. 

Posterior  superior  dental:  comes  off  just  before  nerve  enters 
canal,  and  divides  into  : — 

External  branch  :  passes  downwards  to  the 'gums. 

Internal  branch  :  enters  a  canal  in  the  superior  maxilla,  and 
runs  along  outer  wall  of  antrum ;  supplies  the  molar  teeth 
and  mucous  membrane  of  the  antrum.  Communicates  with 
middle  superior  dental. 


NERVES  145 

Branches  arising  within  the  infra-orbital  canal : — 

Middle  and  anterior  superior  dental :  descend  in  canals  in 
anterior  wall  of  antrum,  and  divide  into  branches. 

The  anterior  supplies  incisor  and  canine  teeth. 

The  middle  supplies  the  bicuspid  teeth. 

Branches  arising  on  the  face : — 

Inferior  palpebral:  supplies  integument  of  lower  eyelid, 
communicating  with  facial,  and  rnalar  of  orbital. 

Nasal :  to  integument  of  side  of  nose.  Joins  nasal  of 
ophthalmic. 

Labial :  three  or  four  branches  to  integument  of  upper  lip. 

The  SPHENO-PALATINE  or  MECKEL'S  GANGLION  is  deeply 
placed  in  the  spheno-maxillary  fossa,  near  the  spheno-palatine 
foramen. 

Roots  :— 

Motor  from  the  facial.     (Large  superficial  petrosal  nerve.) 

Sympathetic  from  the  carotid  plexus.  (Large  deep  petrosal 
nerve.)  See  Vidian  nerve,  p.  146. 

Sensory  from  the  superior  maxillary.  (Spheno-palatine 
nerves.) 

Branches  of  distribution  : — 

Ascending  :  three  or  four  small  branches  to  the  periosteum 
of  the  orbit. 

Descending :  mostly  continuous  with  spheno  -  palatine  of 
superior  maxillary  nerve. 

The  anterior  or  large  palatine  nerve  passes  through  large 
posterior  palatine  canal  to  hard  palate,  there  dividing  into 
branches  which  run  forward  in  grooves  in  the  bone  nearly  to 
the  incisor  teeth,  joining  the  naso-palatine  nerve  in  the  region 
of  anterior  palatine  canal.  It  supplies  the  gums  and  mucous 
membrane  of  hard  palate.  Whilst  in  the  posterior  palatine 
canal  it  gives  off  the  inferior  nasal  branches  which  supply 
mucous  membrane  on  middle  and  inferior  spongy  bones. 

The  posterior  or  small  palatine  nerve  enters  smaller  posterior 
palatine  canal  to  supply  mucous  membrane  of  soft  palate, 
uvula  and  tonsil. 

The  external  palatine  nerve  passes  through  external  palatine 
canal  to  the  tonsil  and  soft  palate. 

Internal. 

Superior  nasal  (4  or  5)  through  spheno-palatine  foramen  to 
supply  the  posterior  and  upper  part  of  the  superior  meatus. 

The  naso-palatine  nerve  (nerve  of  Cotunnius)  passes  inwards 
through  spheno-palatine  foramen,  crosses  roof  of  nasal  fossa 
to  septum,  on  which  it  passes  downwards  and  forwards  with 
its  fellow  of  the  opposite  side  to  the  foramina  of  Scarpa  in 
anterior  palatine  canal,  the  left  nerve  being  anterior,  and, 

10 


146  THE  POCKET  ANATOMY 

communicating  with  the  large  palatine  nerve,  ends  in  the 
gums  of  the  incisor  teeth.  Branches  are  given  to  the  mucous 
membrane  over  the  septum. 

Posterior. 

The  Vidian  nerve,  really  formed  by  two  roots  of  the  ganglion, 
passes  backwards  through  Vidian  canal,  here  giving  off  the 
upper  posterior  nasal  branches  to  the  back  part  of  the  roof  of  the 
nose.  On  emerging  from  the  canal  it  divides  in  the  foramen 
lacerum  medium  into  a  large  deep  petrosal  nerve,  which  joins 
the  sympathetic  on  the  carotid  artery,  and  a  large  superficial 
petrosal  nerve,  which  runs  along  a  groove  on  the  petrous  bone 
to  the  hiatus  Fallopii,  and,  passing  into  the  Fallopian  aque- 
duct, joins  the  geniculate  ganglion  on  the  facial  nerve.  As 
the  motor  root  of  Meckel's  ganglion,  it  may  be  traced  forwards 
from  facial  nerve. 

Thepharyng  al  nerve,  which  may  come  off  from  the  ganglion, 
or  from  the  Vidian  nerve,  enters  pterygo-palatine  canal  and 
ends  in  the  mucous  membrane  of  the  palate,  near  the 
Eustachian  tube. 

The  INFERIOR  MAXILLARY  NERVE  is  the  largest  of  the  three 
divisions  of  the  5th.  The  large  sensory  root  comes  from  the 
inferior  angle  of  the  Gasserian  ganglion,  which  root  is  joined 
on  its  deep  aspect  near  or  in  the  foramen  ovale  by  the  small 
motor  root  from  the  trunk  of  the  5th  nerve.  The  united 
nerve  leaves  skull  by  foramen  ovale,  and  immediately  divides 
into  anterior  and  posterior  trunks. 

Branches  from  the  trunk  : — 

Recurrent :  passes  backwards  with  the  middle  meningeal 
artery,  through  foramen  spinosum,  to  supply  dura  mater. 

Internal  pterygoid  :  to  deep  surface  of  internal  pterygoid, 
connected  near  origin  with  otic  ganglion. 

Branches  from  the  anterior  (small  and  chiefly  motor}  division: — 

Masseteric  :  passes  outwards  with  posterior  deep  temporal 
nerve  above  external  pterygoid,  then  over  sigmoid  notch  with 
artery,  to  deep  surface  of  masseter  and  gives  twigs  to  temporo- 
maxillary  joint. 

Deep  temporal  (3) :  anterior,  from  the  buccal  nerve,  to  supply 
front  of  temporal  muscle;  middle,  passes  above  external  ptery- 
goid to  deep  part  of  temporal  muscle  ;  posterior,  often  united 
with  masseteric  nerve,  to  back  part  of  temporal  muscle. 

Buccal  (sensory) :  comes  out  between  heads  of  external 
pterygoid  to  reach  buccinator,  and  is  frequently  joined  to 
the  anterior  temporal  and  external  pterygoid  nerves ;  com- 
municates with  facial,  and  is  distributed  to  mucous  membrane 
and  skin  of  cheek. 


NERVES  147 

External  pterygoid  :  to  external  pterygoid  (generally  given 
off  from  buccal) . 

Branches  from  the  posterior  (large  and  chiefly  sensory) 
division  : — 

The  auriculo-temporal  nerve  comes  off  by  two  roots,  be- 
tween which  the  middle  meningeal  artery  passes ;  runs  back- 
wards under  external  pterygoid  muscle,  round  temporo-maxil- 
lary  capsular  ligament,  then  upwards,  with  superficial  temporal 
artery,  beneath  parotid  to  temporal  fossa,  where  it  becomes 
cutaneous,  and  lies  posterior  to  superficial  temporal  artery. 

Branches  of  the  Auriculo-temporal : — 

Inferior  auricular :  to  ear  below  meatus. 

Superior  auricular :  to  integument  of  tragus,  pinna,  and  to 
membrana  tympani. 

Communicating  :  to  otic  ganglion  and  facial. 

Superficial  temporal :  to  scalp  with  artery,  joins  temporal 
branches  of  facial. 

Parotid :  to  gland. 

Temporo-maxillary :  to  joint. 

The  inferior  dental  nerve  passes  down  internal  to  externa: 
pterygoid  muscle,  and  posterior  to  the  lingual  nerve ;  then 
between  the  ramus  of  jaw  and  internal  lateral  ligament,  to 
the  inferior  dental  foramen,  along  which  canal  it  runs  at  first 
anterior  and  then  above  the  dental  artery.  It  supplies  the 
molar  and  bicuspid  teeth,  and  emerges  at  the  mental  foramen, 
having  just  previously  divided  into  two  branches,  one  of  which 
(incisor)  is  continued  in  the  bone,  and  the  other  (mental)  it-, 
continued  over  the  chin. 

Branch  before  entering  the  dental  foramen : — 

Mylo-hyoid :  descends  in  a  groove  on  the  inner  side  of  ramus 
of  jaw  to  outer  side  of  mylo-hyoid  muscle,  supplying  it  and 
giving  a  branch  to  the  anterior  belly  of  the  digastric. 

Branches  given  off  in  the  dental  canal : — 

Dental:  to  molars  and  bicuspids. 

Incisor:  to  canine  and  incisors. 

Mental:  passes  out  ol  mental  foramen,  and  divides  into 
branches  which  supply  integument  of  chin  and  lower  lip,  and 
communicate  with  the  facial. 

The  gustatory  or  lingual  nenr*  lies  at  first  internal  to  the 
external  pterygoid  muscle ;  it  then  passes  downwards  in  front 
of  the  inferior  dental  nerve,  and  is  joined  at  an  acute  angle 
by  the  chorda  tympani  from  the  facial.  Thence  it  passes  down- 
wards and  forwards  between  internal  pterygoid  and  ramus, 
over  the  superior  constrictor  of  the  pharynx  and  on  the  hyo- 
glossus  above  the  deep  part  of  submaxillary  gland,  to  the 

10 — 2 


1 48  THE  POCKET  ANATOMY 

side  of  the  tongue,  and,  crossing  Wharton's  duct  externally, 
is  continued  to  the  tip  of  the  tongue 

Branches : — 

Communicating:  with  inferior  dental  at  commencement ;  with 
facial  through  chorda  tympani ;  branches  are  sent  also  to 
submaxillary  ganglion  and  the  hypoglossal  nerve. 

Distributary:  to  mucous  membrane  of  sides  and  tip  of  tongue, 
the  gums  and  sublingual  gland,  the  terminal  branches  supply- 
ing anterior  f  of  mucous  membrane  of  dorsum. 

The  SUBMAXILLARY  GANGLION  lies  between  the  hyoglossus 
muscle  and  the  deep  part  of  the  submaxillary  gland. 

Roots : — 

Motor  and  sensory :  the  connecting  branch  from  the  lingual 
supplies  sensory  and  motor  from  the  facial,  through  the  chorda 
tj'mpani. 

Sympathetic :  from  plexus  round  facial  artery. 

Branches : — 

Five  or  six  small  twigs  supply  the  submaxillary  gland,  the 
mucous  membrane,  and  Wharton's  duct. 

The  OTIC  GANGLION  (Arnold's)  lies  on  the  inner  surface  of 
the  inferior  maxillary  nerve,  close  to  the  foramen  ovale,  and 
is  connected  with  the  commencement  of  the  nerve  to  the 
internal  pterygoid  muscle. 

Roots  :— 

Motor  and  sensory:  from  the  inferior  maxillary,  by  the 
branch  to  the  internal  pterygoid. 

Sympathetic :  from  plexus  on  middle  meningeal  artery,  which 
lies  just  behind  it. 

The  small  superficial  petrosal  nerve  passes  into  the  posterior 
part  of  the  ganglion  connecting  it  with  the  facial  and  glosso- 
pharyngeal  nerves. 

Branches : — 

Communicating:  to  auriculo- temporal,  and  to  chorda  tym 
pani. 

Muscular:  to  the  tensor  tympani,  and  tensor  palati. 


SYNOPSIS  OF  THE  FIFTH  NERVE. 

BRANCHES. 

Ophthalmic. 

Recurrent. 
Lachrymal  : 

Lachrymal. 
Palpebral. 


NERVES  149 

Ophthalmic  (continued) : 
Frontal : 

Supra-orbital. 
Supra-trochlear 
Na  sal  : 

Ganglionic. 

Long  ciliary. 

Infra-trochlear.  f 

Nasal,  internal  and  external  . 

Superior  Maxillary. 
Recurrent. 
Orbital : 

Malar.    .  i 

Temporal. 
Spheno-palatine. 
Posterior  superior  dental. 
Middle  and  anterior  superior  dental. 
Infra-orbital. 
Inferior  palpebral. 
Nasal. 
Labial. 

In'erior  Maxillary. 
Recurrent. 
Internal  pterygoid. 
Anterior,  small  or  motor  part : 
Deep  temporal. 
Masseteric. 
Buccal  (sensory). 
External  pterygoid. 
Posterior,  large  or  sensory  part. 
Auricula -temp  oval : 

Auricular,  inferior  and  superior. 
Parotid. 

Temporal,  superficial. 
Temporo-maxillary. 
Communicating. 
Inferior  dental : 

Mylo-hyoid  (motor). 
Dental. 
Mental. 
Incisor. 
Lingual  : 

Communicating  to  inferior  dental,  sub- 
maxillary  ganglion,  and  hypoglossal. 
Distributory  to  tongue. 


150  THE  POCKET  ANATOMY 

GANGLIA  IN  CONNECTION  WITH  THE  5TH  NERV* 
Lenticular  Ganglion. 
Roots  : 

From  nasal. 
From  3rd  nerve. 
From  sympathetic. 
Branch  of  Distribution : 
Short  ciliary  nerves. 

Meckel's  Ganglion. 

Roots  : 

Facial.  \Vidian, 

Carotid  plexus.  J 

Superior  maxillary. 
Internal  Branches  : 

Nasal. 

Nasopalatine. 
Ascending : 

Orbital. 
Descending : 

Large  palatine. 

Small  palatine. 

External  palatine. 
Posterior  : 

Superior  nasal. 

Pharyngeal. 

Submaxillary  Ganglion, 

Roots  : 

Lingual. 

Chorda  tympani. 

Sympathetic. 
Distributary  : 

To  gland,  etc. 

Otic  Ganglion. 

Roots  : 

Inferior  maxillary. 

Sympathetic. 

Small  superficial  petrosal. 
Branches : 

To  auriculo-temporal. 

Chorda  tympani. 

To  Tensor  tympani. 

To  Tensor  palati. 


NERVES  151 

The  6xH  or  ABDUCENS  OCULI.  Origin  —  Superficial:  from 
the  sulcus  between  the  pons  and  medulla,  anterior  to  the 
anterior  pyramid.  Deep  :  floor  of  4th  ventricle  beneath 
fasciculus  teres. 

Course.—  Pierces  dura  mater  on  basilar  process  and  grooves 
side  of  dorsum  ephipii  to  reach  cavernous  sinus;  lies  to 
outer  side  of  internal  carotid,  and  below  the  other  nerves. 
Enters  orbit  by  sphenoidal  fissure,  between  the  heads  of  the 
external  rectus,  lying  above  ophthalmic  vein. 

Distribution.  —  External  rectus  (ocular  surface). 

Relations.  —  The  following  table  shows  how  the  nerves  of  the 
orbit  change  their  position  to  one  another.  They  lie  from 
above  down. 

In  ^Cavernous  /w  ^  sphenoidal  Fi,sure. 

Third.         Fourth.     Frontal.     Lachrymal. 
Fourth.  (Above  the  muscles.) 

Fifth.          Superior  division  o 


Sixth 

The  7TH  or  FACIAL.  Origin  —  Superficial  :  from  the  pons,  ex- 
ternally and  posteriorly,  on  its  ventral  surface.  Deep  :  floor 
of  4th  ventricle,  anterior  and  external  to  nucleus  of  6th  nerve. 

Course.  —  Passes  forwards  and  outwards  to  enter  the  internal 
auditory  meatus  ;  it  lies  upon  a  groove  on  the  auditory  nerve, 
with  pars  intermedia  of  Wrisberg  between,  and  at  the 
bottom  of  the  meatus  the  latter  joins  the  facial,  which 
entering  the  aqueductus  Fallopii,  runs  first  outwards 
above  and  between  cochlea  and  vestibule  as  far  as  hiatus 
Fallopii  ;  then  backwards  in  internal  wall  of  tympanum,  just 
above  fenestra  ovalis,  at  the  bend  presenting  a  swelling,  the 
geniculate  ganglion  ;  and  finally  it  passes  downwards,  to  emerge 
from  the  bone  at  the  stylo-mastoid  foramen  ;  it  then  passes 
outwards  and  forwards  in  the  parotid,  dividing  behind  the 
ramus  of  jaw  into  temporo-facial  and  cervico-facial  branches, 
which  further  subdivide  and  intercommunicate,  forming  the 
pes  anserimis. 

Communications  :  — 

In  the  meatus,  with  auditory  and  pars  intermedia. 

In  the  aqueduct,  with  Meckel's  ganglion  by  large  superficial 
petrosal  ;  otic  ganglion  by  small  superficial  petrosal  ;  plexus  on 
middle  meningeal  by  external  superficial  petrosal. 


152  THE  POCKET  ANATOMY 

At  exit  from  foramen,  with  pneumogastric,  glosso-pharyngeal, 
carotid  plexus,  great  auricular,  auriculo-temporal. 

On  the  face,  with  the  three  divisions  on  the  $th. 

Branches  within  the  Aqueduct : — 

Communicating  from  the  geniculate  ganglion  tc  the  audi- 
tory. 

Large  superficial  petrosal  passes  from  geniculate  ganglion 
through  hiatus  Fallopii,  then  through  foramen  lacerum 
medium  to  Vidian  canal,  where  it  joins  the  large  deep  pe- 
trosal  to  form  the  Vidian  nerve  (vide  p.  146). 

Communicating  with  the  small  superficial  petrosal  nerve 
(vide  pp.  148  and  154). 

External  superficial  petrosal :  from  geniculate  ganglion  to 
plexus  on  middle  meningeal  artery. 

Tympanic  :  to  the  stapedius. 

Chorda  tympani :  given  off  just  before  exit  from  stylo- 
mastoid  foramen,  ascends  to  tympanum  through  iter  chorda 
posterius;  it  courses  then  between  membrana  tympani  and 
base  of  pyramid,  and  between  handle  of  malleus  and  long 
process  of  incus ;  it  leaves  tympanum  by  iter  chorda  anterius, 
and,  passing  through  Huguier's  canal,  emerges  at  the  inner 
end  of  the  Glaserian  fissure,  then  forwards  between  two 
pterygoids  to  join  gustatory  or  lingual.  It  forms  the  sensory 
root  of  submaxillary  ganglion,  and  ends  in  the  tongue. 

Communicating  with  the  auricular  branch  (Arnold's  nerve) 
of  the  pneumogastric. 

Branches  given  off  at  exit  from  Foramen  : — 

Posterior  auricular :  passes  up  behind  and  between  mastoid 
process  and  meatus,  dividing  into  auricular  to  supply  retrahens 
and  attollens  aurem,  and  occipital  to  posterior  belly  of  occipito- 
frontalis;  communicates  with  auricular  of  pneumogastric, 
great  auricular,  and  small  occipital. 

Stylo-hyoid  :  to  muscle. 

Digastric :  given  off  with  former  to  supply  posterior  belly 
of  digastric,  communicates  with  glosso-pharyngeal. 

Branches  on  the  Face : — 

Divides  near  ramus  of  inferior  maxilla  into  temporo-facial 
and  cervico-facial. 

The  TEMPORO-FACIAL  crosses  over  external  carotid  and 
temporo-maxillary  vein,  communicating  with  auriculo-tem- 
poral and  supplying  pinna. 

Branches  of  the  Temporo-facial : — 

Temporal :  supply  attrahens  aurem,  joining  temporal  of 
superior  maxillary  and  auriculo-temporal  of  inferior  maxil- 
lary ;  anterior  branches  supply  orbicularis  palpebrarum  and 


NERVES  153 

anterior  belly  of  occipito-frontalis,  joining  lachrymal  and 
supra-orbital  nerves. 

Malar :  to  supply  eyelid  muscles,  and  join  supra-orbital. 

Infra-orbital :  superficial,  to  superficial  muscles  of  the  face, 
join  infra- trochlear,  and  nasal  (5th).  Deep,  to  elevators  of 
upper  lip  and  angle  of  mouth,  join  infra-orbital  of  superior 
maxillary. 

The  CERVICO-FACIAL  passes  downwards  and  forwards  in 
parotid,  receiving  communications  from  the  great  auricular 
nerve. 

Branches  of  the  Cervico- facial : — 

Buccal :  to  buccinator  and  orbicularis  oris ;  joins  buccal 
of  inferior  maxillary. 

Supra-mandibular  :  to  muscles  of  lip  and  chin  ;  join  mental 
branch  of  inferior  dental. 

Infra-mandibular :  perforates  deep  cervical  fascia  be- 
neath lower  jaw,  to  join  superficial  cervical  and  supply 
platysma. 

The  STH  or  AUDITORY  NERVE.  Origin — Superficial :  Mesial 
Root :  between  pons  and  restiform  body.  Lateral  Root :  floor 
of  the  4th  ventricle,  by  the  striae  acusticae.  Deep — both  roots: 
auditory  nuclei  in  floor  of  4th  ventricle. 

Course. — Passes  round  restiform  body  to  posterior  border 
of  crus  cerebelli  with  facial ;  it  then  enters  the  internal 
auditory  meatus  with,  the  facial  nerve,  the  latter  lying  in  a 
groove  on  its  upper  surface,  and  divides  at  the  bottom  into 
coJilear  and  vestibular  branches. 

Distribution.  —  Cochlear,  supplies  cochlea,  saccule  and 
posterior  semicircular  canal ;  vestibular,  to  utricle  and 
superior  and  external  semicircular  canals  (vide  Ear,  p.  236). 

The  QTH  or  GLOSSO-PHARYNGHAL  NERVE.  Origin — Super- 
ficial: from  the  upper  part  of  the  medulla,  in  the  groove 
between  the  olive  and  restiform  body.  Deep :  floor  of  4th 
ventricle. 

Course. — Passes  outwards  over  the  flocculus  to  the  jugular 
foramen.  Leaves  the  skull  with  the  pneumogastric  and  spinal 
accessory,  but  in  a  separate  tube  of  dura  mater  and  in  front 
and  external  to  them,  being  contained  in  a  canal  in  the 
petrous  part  of  the  temporal  bone.  It  presents  near  point  of 
exit  two  ganglionic  enlargements — the  jugular  and  petrous. 
Issuing  from  the  skull,  the  nerve  passes  downwards  and  out- 
wards between  the  internal  carotid  artery  and  jugular  vein, 
and  then  forwards  over  the  internal  carotid  artery,  down- 
wards behind  the  muscles  attached  to  the  styloid  process,  to 
reach  the  lower  border  of  the  stylo-pharyngeus.  Thence  it 


154  THE  POCKET  ANATOMY 

is  inclined  inwards  on  the  middle  constrictor  beneath  the 
hyo-glossus  to  the  tongue,  pharynx,  and  tonsil. 

The  jugular  ganglion  :  the  smaller  of  the  two  is  situated  at 
the  upper  part  of  the  groove  in  the  temporal  bone  through 
which  the  nerve  passes.  It  involves  only  the  outer  side  of 
the  trunk  of  the  nerve. 

The  petrous  ganglion  is  placed  in  a  depression  on  the  in- 
ferior border  of  the  petrous  bone. 

Branches  : — 

Connecting,  from  petrous  ganglion  : 

(a)  To  superior  cervical  ganglion  of  sympathetic. 

(b\  To  auricular  of  pneumogastric. 

(c)  To  ganglion  of  root  of  the  pneumogastric. 

Tympanic  (Jacobson's  nerve):  arising  from  the  petrous 
ganglion,  enters  a  minute  canal  in  the  bone  between  jugular 
foramen  and  carotid  canal  to  reach  the  inner  wall  of  the 
tympanum  ;  runs  in  a  groove  over  the  promontory,  giving 
off  several  branches,  and,  after  communicating  with  the 
facial,  is  continued  forwards  as  the  small  superficial  petrosal 
nerve  (vide  p.  148).  This  nerve  pierces  the  petrous  portion  of 
the  temporal  to  reach  the  middle  fossa  just  external  to  the 
hiatus  Fallopii,  and,  passing  through  the  petro-sphenoidal 
suture,  ends  in  the  otic  ganglion.  It  divides  into  six  branches, 
which  form  the  tympanic  plexus  on  the  promontory. 

Three  branches  of  communication,  to  the  carotid  plexus  and 
small  deep  petrosal  nerve,  to  the  great  superficial  petrosal 
nerve,  and  to  the  otic  ganglion  respectively. 

Three  branches  of  distribution,  to  thefenestraovalis,  fenestra 
rotunda,  and  mucous  membrane  of  the  Eustachian  tube 
respectively. 

Pharyngeal  (3  or  4)  :  cross  the  internal  carotid  and  join 
opposite  the  middle  constrictor  with  pharyngeal  of  pneumo- 
gastric and  sympathetic,  to  form  pharyngeal  plexus,  supply- 
ing the  mucous  membrane  of  the  pharynx. 

Communicating  with  digastric  branch  of  facial. 

Muscular :  to  stylo-pharyngeus  and  mucous  membrane 
of  upper  part  of  pharynx. 

Tonsillitic :  to  the  tonsil  forming  plexus,  the  circulus  ton- 
sillaris,  and  thence  to  fauces  and  soft  palate. 

Lingual  (2) :  one  branch  distributed  to  the  base  supplying 
the  circumvallate  papillae,  the  other  to  the  posterior  §  of 
side  of  the  tongue. 

Special  functions. — Nerve  of  sensation  to  the  mucous  mem- 
brane of  pharynx,  fauces  and  tonsil ;  of  motion  to  stylo- 
pharyngeus  muscle ;  and  of  taste  of  the  tongue. 


NERVES  155 

The  IOTH  NERVE — the  PNEUMOGASTRIC  or  VAGUS.  Origin 
— Superficial ;  sulcus,  between  restiform  and  olivary  bodies. 
Deep  :  Trigonum  vagi  on  floor  of  4th  ventricle. 

Course. — Passes  from  origin  over  the  flocculus  to  jugular 
foramen,  through  which  it  passes  in  same  sheath  with  spinal 
accessory  and  behind  the  glosso-pharyngeal  ;  in  the  foramen 
it  presents  the  ganglion  of  the  root.  Upon  leaving  the  fora- 
men, it  is  connected  with  the  accessory  part  of  the  spinal 
accessory,  and  forms  an  enlargement,  the  ganglion  of  the 
trunk.  The  accessory  part  of  the  spinal  accessory  nerve 
passes  over  the  ganglion,  some  fibres  joining  the  trunk  of  the 
nerve,  but  the  principal  portions  are  continued  into  the 
pharyngeal  and  superior  laryngeal  branches.  Thence  the 
nerve  passes  down  in  the  carotid  sheath,  behind  and  between 
the  artery  and  vein,  to  the  root  of  the  neck,  where  its  course 
on  each  side  of  the  body  becomes  different. 

The  right  nerve  passes  between  ist  part  of  subclavian  artery 
and  subclavian  vein,  and  down  by  side  of  trachea  and  behind 
right  innominate  vein  to  posterior  part  of  the  root  of  the  right 
lung,  forming  the  posterior  pulmonary  plexus  ;  thence  proceed 
two  cords,  which  run  down  on  the  oesophagus,  communicate 
with  nerve  of  opposite  side  (cesophageal  plexus),  join  belowinto 
one  trunk,  which  lies  behind  oesophagus,  and  passing  through 
cesophageal  orifice  in  diaphragm  is  distributed  to  the  posterior 
surface  of  the  stomach,  joining  solar  and  splenic  plexuses. 

The  left  nerve  passes  down  between  the  left  subclavian  and 
carotid  arteries,  and  behind  the  left  innominate  vein,  where 
the  left  phrenic  crosses  it ;  thence  in  front  of  the  arch  of  aorta 
to  posterior  surface  of  root  of  left  lung,  forming  the  posterior 
pulmonary  plexus;  then  along  the  anterior  surface  of 
oesophagus  through  diaphragm,  to  be  distributed  on  the 
anterior  surface  of  stomach,  and  join  left  hepatic  plexus. 

Connecting  branches  : — 

The  ganglion  of  the  root  is  connected  to  the  spinal  accessory, 
petrous  ganglion  of  the  glosso-pharyngeal  and  sympathetic 
nerves. 

The  ganglion  of  the  trunk  is  connected  with  the  hypo- 
glossal,  sympathetic,  and  loop  between  ist  and  2nd  cervical 
nerves. 

Branches : — 

Recurrent :  from  the  upper  ganglion,  passes  backwards  to 
the  dura  mater  of  the  posterior  fossa. 

Auricular  (Arnold's) :  from  the  ganglion  of  the  root,  com- 
municates with  the  petrous  ganglion  of  the  glosso-pharyngeal, 
and  enters  a  foramen  between  the  root  of  the  styloid  process 


156  THE  POCKET  ANATOMY 

and  jugular  fossa.  It  passes  through  the  temporal  bone  com- 
municating with  the  facial,  and  emerges  by  the  auricular 
fissure  just  behind  the  external  auditory  meatus.  Finally  it 
divides  into  two  branches,  to  supply  the  back  of  the  pinna, 
which  inosculate  with  the  posterior  auricular  of  the  facial. 

Pharyngeal :  principally  formed  by  fibres  from  the  accessory 
of  spinal  accessory,  passes  superficial  to  internal  carotid  artery 
to  upper  part  of  middle  constrictor,  where  it  joins  branches 
from  glosso-pharyngeal,  superior  laryngeal,  and  sympathetic 
to  form  the  pharyngeal  plexus. 

Superior  laryngeal :  from  the  ganglion  of  the  trunk,  passes 
down  behind  internal  carotid  artery,  where  it  divides  into 
external  laryngeal  nerve,  which  communicates  with  pharyngeal 
plexus  and  upper  cardiac  of  sympathetic,  supplies  the  crico- 
thyroid  and  inferior  constrictor  muscle  and  internal  laryngeal 
nerve,  which  passing  through  thyro-hyoid  membrane,  is  dis- 
tributed to  the  mucous  membrane  of  the  larynx,  and  com- 
municates with  a  branch  from  the  recurrent  laryngeal. 

Inferior  or  recurrent  laryngeal :  the  right  nerve  arises  in 
front  of  subclavian  artery,  winds  back  round  it,  and  passes  up 
behind  common  carotid  and  inferior  thyroid  arteries  to  right 
side  of  trachea.  The  left  nerve  arises  on  front  of  arch  of 
aorta,  round  which  it  winds  to  the  left  of  the  ductus  arteriosus 
and  passes  up  by  left  side  of  trachea.  Both  nerves  ascend  in  a 
groove  between  trachea  and  oesophagus,  and  enter  larynx  by 
passing  under  lower  border  of  inferior  constrictor  muscle. 
The  nerve  supplies  all  the  muscles  of  the  larynx  (except  the 
crico- thyroid),  the  inferior  constrictor,  communicates  with 
the  internal  branch  of  the  superior  laryngeal,  and  gives 
branches  to  the  cardiac  plexus,  inferior  cervical  ganglion  of 
the  sympathetic,  to  the  trachea,  and  to  the  oesophagus. 

Cervical  cardiac  (2  or  3)  :  Superior  are  small ;  join  cardiac 
of  sympathetic.  Inferior,  one  on  either  side,  arise  just  above 
ist  rib  ;  the  right  one  passes  by  the  side  of  innominate 
artery  and  joins  deep  cardiac  plexus ;  the  left  one  descends 
in  front  of  the  arch  of  the  aorta,  and  joins  superficial  cardiac 
plexus. 

Thoracic  cardiac :  right  ones  from  the  trunk  of  the  nerve, 
end  in  deep  cardiac  plexus.  Left  ones  arise  from  left  recurrent 
laryngeal. 

Anterior  pulmonary  (2  or  3) :  to  anterior  part  of  root  of 
lung,  joining  with  sympathetic  to  form  the  anterior  pulmonary 
plexus. 

Posterior  pulmonary :  numerous,  to  posterior  part  of  root 
oi  lung,  which  join  branches  from  2nd,  3rd,  and  4th  thoracic 


NERVES  157 

ganglia  of  sympathetic,  forming  the  posterior  pulmonary 
plexus. 

CEsophageal :  to  oesophagus,  forming  a  plexus  (plexus  gulae) 

Gastric :  the  right  nerve  is  distributed  to  posterior  part  of 
stomach,  and  ends  in  the  solar,  splenic  and  left  renal  plexuses. 
The  left  supplies  the  anterior  surface  and  ends  in  the  left 
hepatic  plexus. 

THE  IITH  or  SPINAL  ACCESSORY  NERVE.  Origin — Super- 
ficial: the  accessory  part  from  the  lateral  tract  below  vagus, 
the  spinal  part  from  the  side  of  the  cord  as  low  down  as  the 
5th  cervical  nerve.  Deep :  anterior  horn  of  grey  matter  of 
medulla,  and  of  cord  as  low  as  5th  cervical  nerve. 

Course. — The  accessory  part  passes  out  of  the  jugular  foramen 
close  to  the  pneumogastric,  and  sends  one  or  two  branches  to 
the  ganglion  of  the  root.  It  does  not  blend  with  the  ganglion 
of  the  trunk,  but  joins  vagus  below.  The  principal  part  joins 
pharyngeal  and  superior  laryngeal  branches,  but  offsets  are 
sent  to  the  cardiac  and  inferior  laryngeal  branches.  The 
spinal  part  enters  skull  through  foramen  magnum  and  passes 
to  jugular  foramen  ;  it  is  enclosed  in  the  same  sheath  of  dura 
mater  as  the  vagus.  Issuing  from  the  foramen,  it  passes  down- 
wards between  internal  carotid  artery  and  internal  jugular 
vein,  and  then  backwards  superficial  to  the  internal  jugular 
vein  to  upper  part  of  sterno-mastoid,  which  it  pierces,  at  the 
same  time  communicating  with  the  branch  to  the  muscle 
from  the  cervical  plexus.  Crossing  the  occipital  part  of  the 
posterior  triangle,  it  enters  the  under  surface  of  the  trapezius, 
where  it  joins  with  branches  of  the  3rd  and  4th  cervical 
nerves  to  form  a  plexus  in  the  substance  of  the  muscle. 

Distribution. — Supplies  sterno-mastoid  and  trapezius  muscles. 

THE  I2TH  or  HYPOGLOSSAL  NERVE.  Origin — Superficial: 
by  ten  or  twelve  filaments,  from  the  groove  between  the 
olivary  body  and  anterior  pyramid.  Deep:  nucleus  beneath 
trigonum  hypoglossi  in  floor  of  4th  ventricle. 

Course. — The  nerve  passes  in  two  bundles  through  anterior 
7ondyloid  foramen,  then  downwards  and  forwards  between 
vagus  and  spinal  accessory,  between  internal  carotid  artery 
and  internal  jugular  vein  to  the  lower  border  of  the  digastric 
muscle ;  curving  round  the  occipital  artery,  it  crosses  the 
external  carotid  and  lingual  arteries,  and  passing  between 
the  mylo-hyoid  and  hyo-glossus  muscles,  ends  by  dividing 
into  branches  on  the  genio-hyo-glossus. 

Branches : — 

Communicating.  To  the  ganglion  of  the  trunk  of  pneumo 
gastric 


158  THE  POCKET  ANATOMY 

To  the  upper  cervical  ganglion  of  the  sympathetic. 

To  the  loop  between  ist  and  2nd  cervical. 

To  the  lingual  branch  from  the  pharyngeal  plexus. 

To  the  lingual  of  the  5th,  on  the  hyo-glossus. 

Distributing : — 

Descendens  cervicis  vel  hypoglossi :  a  slender  branch,  given 
off  as  the  nerve  hooks  round  occipital  artery,  passes  down 
over  carotid  sheath,  joining  in  a  loop  with  branch  from  2nd 
and  3rd  cervical  (communicans  hypoglossi) ;  from  this  loop 
muscular  branches  are  given  to  sterno-hyoid,  sterno-thyroid, 
and  the  two  bellies  of  the  omo-hyoid.  This  branch,  and  those 
to  thyro-hyoid  and  genio-hyoid,  do  not  arise  from  hypoglossal 
nucleus,  but  are  derived  from  communication  above  with  ist 
and  2nd  cervical,  and  merely  pass  down  with  hypoglossal. 

Thyro-hyoid :  passes  round  great  cornu  of  hyoid  bone  to 
supply  thyro-hyoid. 

Muscular :  to  stylo-glossus,  hyo-glossus,  genio-hyoid,  genio- 
hyo-glossus  and  intrinsic  muscles  of  the  tongue. 


THE  SPINAL  NERVES. 

There  are  31  pairs  of  spinal  nerves,  viz. :  8  cervical, 
12  dorsal,  5  lumbar,  5  sacral,  and  i  coccygeal.  Each  nerve 
arises  from  the  spinal  cord  by  an  anterior  (motor)  and  a 
posterior  (sensory)  root,  the  latter  having  a  ganglion  developed 
upon  it.  These  roots  join  together  in  the  inter  vertebral 
foramen,  and  upon  issuing  from  it  immediately  split  up  again 
into  two  parts,  the  anterior  and  posterior  primary  divisions, 
each  containing  fibres  from  the  two  roots.  The  anterior 
primary  divisions  supply  the  parts  in  front  of  the  spine,  the 
posterior  primary  divisions  the  parts  behind  that  column. 

The  posterior  primary  divisions  of  the  spinal  nerves  are 
generally  smaller  than  the  anterior,  and  pass  directly  back- 
wards, each  quickly  dividing  into  an  external  and  an  internal 
branch,  to  supply  the  muscles  and  integuments  behind  the 
spine.  To  this  general  rule  there  are  a  few  exceptions,  as 
posterior  primary  divisions  of  the  ist  cervical,  the  4th  and 
5th  sacral,  and  the  coccygeal  nerves  do  not  thus  subdivide. 


THE  CERVICAL  NERVES. 
THE  POSTERIOR  PRIMARY  DIVISIONS. 
The  first  cervical  nerve.— The  posterior  primary  division 
of  the  ist  cervical  or  sub-occipital  nerve  passes  backwards 


NEfi  VES  159 

beneath  the  vertebral  artery  on  the  posterior  arch  of  atlas, 
and,  entering  the  sub-occipital  triangle,  divides  into  branches 
to  supply  the  inferior  oblique,  which  branch  communicates 
with  the  2nd  cervical  nerve,  the  recti  postici  major  and  minor, 
the  superior  oblique,  and  the  complexus. 

With  the  exception  of  the  sub-occipital  nerve,  the  posterior 
primary  divisions  of  the  cervical  nerves  divide  into  : — 

External  branches  :  for  the  muscles  behind  the  spine. 

Internal  branches  are  larger  than  the  external  branches, 
and,  with  the  exception  of  that  from  the  2nd  cervical  nerve 
(great  occipital),  pass  to  spinous  processes,  supplying  the 
muscles  on  their  way,  and  become  cutaneous.  The  branch 
from  the  3rd  cervical  nerve  supplies  the  integument  at  the 
base  of  the  occiput  (third  or  least  occipital}.  The  internal 
branches  from  the  6th,  yth,  and  8th  end  in  the  muscles. 

The  great  occipital  nerve  is  the  internal  branch  of  the  posterior 
primary  division  of  the  2nd  nerve.  It  passes  through  the 
complexus  and  trapezius,  and  ascends  with  the  occipital 
artery  to  the  back  of  the  scalp,  communicating  with  the 
small  occipital  nerve.  It  usually  has  an  auricular  branch. 

THE  ANTERIOR  PRIMARY  DIVISIONS. 

The  anterior  primary  divisions  of  the  first  four  cervical 
nerves  form  the  cervical  plexus,  and  those  of  the  lower  four, 
with  part  of  that  of  the  ist  dorsal  nerve,  compose  the  brachial 
plexus. 

The  anterior  primary  divisions  of  the  ist  and  2nd  cervical 
nerves  differ  in  form  from  the  rest. 

The  anterior  primary  division  of  the  1st  cervical  nerve 
passes  outwards  in  the  groove  on  the  outer  side  of  the  upper 
articular  process  of  the  atlas,  lying  behind*  the  vertebral 
artery,  and  giving  a  branch  to  the  rectus  lateralis  and  recti 
antici  capitis  major  and  minor.  It  joins  the  2nd  nerve,  and 
communicates  with  the  sympathetic  on  the  vertebral  artery, 
with  the  superior  cervical  ganglion,  the  pneumogastric,  and 
with  the  hypoglossal  nerves. 

The  second  cervical  nerve :  the  anterior  primary  division 
of  this  nerve  winds  forward  outside  the  vertebral  artery,  and 
divides  into  an  ascending  part  which  joins  the  ist  cervical, 
and  a  descending  part,  which  joins  the  3rd  cervical  nerve. 

The  Cervical  Plexus  is  formed  by  the  union  of  the  anterior 
primary  divisions  of  the  first  four  cervical  nerves  after  each 
has  communicated  with  the  superior  cervical  ganglion.  It  is 
situated  between  the  sterno-mastoid  and  the  middle  scalene 
muscles.  Each  nerve  except  the  ist  divides  into  an  ascending 


160  THE  POCKET  ANATOMY 

branch,  which  connects  it  with  the  nerve  above,  and  a  descending 
branch,  which  joins  it  to  the  nerve  below.  From  the  loop 
between  the  and  and  3rd  nerves  cutaneous  branches  are  given 
off  to  the  head  and  neck,  and  from  the  union  of  the  3rd  and 
4th  nerves  superficial  branches  pass  for  the  shoulder  and 
chest,  together  with  muscular  and  communicating  branches. 

SUPERFICIAL  ASCENDING  BRANCHES  : — 

Superficial  cervical  nerve  :  from  loop  between  2nd  and  3rd 
nerves,  passes  forwards  over  the  middle  of  the  sterno-mastoid, 
perforates  the  cervical  fascia,  and  divides  beneath  platysma 
into : — 

Ascending  Branch  :  accompanies  external  jugular  vein,  com- 
municates with  the  facial,  and  becomes  cutaneous,  supplies 
front  of  upper  half  of  neck. 

Descending :  supplies  integument  as  low  as  sternum. 

Great  auricular:  from  and  and  3rd.  Winds  round  margin 
of  sterno-mastoid  to  reach  parotid  gland.  Gives  off: — 

Facial :  over  parotid  to  integument  of  face. 

Auricular :  to  back  part  of  pinna;  communicates  with  pos- 
terior auricular. 

Mastoid  :  supplying  skin  over  mastoid  process,  joining  with 
posterior  auricular  of  facial  and  small  occipital. 

Small  occipital:  from  and,  ascends  along  posterior  border 
of  sterno-mastoid  to  scalp,  lying  between  ear  and  occipital 
irtery ;  supplies  integument. 

Branch : — 

Auricular  :  supplies  integument  of  cranial  surface  of  auricle. 

SUPERFICIAL  DESCENDING  BRANCH  :  from  3rd  and  4th. 

Branches : — 

Supra-sternal :  to  integument  as  far  as  middle  line. 

Supra-clavicular  :  to  integument  over  pectoral  muscle,  often 
pierces  clavicle. 

Supra-acromial :  to  integument  of  shoulder. 

DEEP  BRANCHES  (Internal) : — 

Communicating :  from  loop  between  ist  and  and,  joins 
sympathetic,  hypoglossal,  and  pneumogastric  nerves. 

Communicans  hypoglossi :  from  and  and  3rd,  form  a  loop 
with  descendens  hypoglossi  in  front  of  carotid  vessels. 

Muscular :  to  prevertebral  muscles  and  through  com- 
munications with  hypoglossal  to  genio-  and  thyro-hyoid. 

Phrenic :  from  3rd  and  4th,  and  a  branch  from  the  5th ; 
lies  in  front  of  scalenus  anticus,  descends  inwards  on  it  in 
front  of  subclavian  artery  to  enter  the  chest,  having  crossed 
the  internal  mammary  artery  at  origin,  behind  the  subclavian 
vein.  In  the  thorax  it  descends  in  front  of  the  root  of  the 


NERVES  161 

lung,  being  between  the  pericardium  and  the  mediastinal 
pleura,  to  the  diaphragm,  which  it  perforates,  and  is  dis- 
tributed on  its  abdominal  surface.  The  right  nerve  lies  to 
right  of  right  innominate  vein  and  superior  vena  cava.  The 
left  nerve  in  the  neck  is  crossed  by  the  thoracic  duct,  and 
below  crosses  the  arch  of  the  aorta  and  left  pneumogastric, 
and  is  longer  than  the  right.  Filaments  from  each  supply 
the  pericardium  and  pleura. 

DEEP  BRANCHES  (External) : — 

Communicating :  to  spinal  accessory  in  sterno-mastoid  and 
trapezius  muscles. 

Muscular  :  to  sterno-mastoid  from  the  2nd,  levator  anguli 
scapulae  from  the  3rd  and  4th,  scalenus  medius  from  the  3rd 
and  4th,  and  trapezius  from  the  3rd  and  4th. 


NERVES  OF  THE  UPPER  EXTREMITY. 

The  BRACHIAL  PLEXUS  is  formed  by  the  union  and  subse- 
quent division  of  the  anterior  primary  divisions  of  the  lower 
four  cervical  and  part  of  anterior  division  of  the  ist  dorsal 
nerves.  The  5th  and  6th  cervical  communicate  with  the 
middle,  and  yth  and  8th  with  inferior  cervical  ganglia.  The 
following  is  the  usual  method  of  union  and  redivision  : — 

The  5th  and  6th  cervical  join  together  at  outer  border  of 
the  scalenus  anticus  to  form  an  upper  trunk. 

The  yth  cervical  forms  a  middle  trunk. 

The  8th  cervical  and  the  ist  dorsal  form  a  lower  trunk. 

Each  of  these  trunks  then  subdivides  into  an  anterior  and 
a  posterior  branch. 

The  anterior  branches  from  the  upper  and  middle  trunks 
form  the  upper  or  outer  cord  of  the  plexus. 

The  anterior  branch  of  the  lower  trunk  forms  the  lower  or 
inner  cord  of  the  plexus. 

The  posterior  branches  of  all  the  trunks  unite  to  form  the 
posterior  or  middle  cord. 

The  subjoined  scheme  will  make  this  arrangement  clear : — 

C  5   }  TT__,      _._i.      (  Posterior 


^  5    L  Upper  trunk     .J  ^»"=VUI  "I 

^  Outer  cord     I  i 

>J 

g8,}'1-- "™k  fet-i™,  lid. 


C,   tMiddl.  trunk    {££!£?      Pc 


The  plexus  lies  between  scalenus  anticus  and  medius, 
and  divides  into  branches  for  the  upper  limb  below  tlu 
pectoralis  minor. 

ii 


162  THE  POCKET  ANATOMY 

Branches  above  the  Clavicle : — 

Muscular  :  to  the  longus  colli  and  scaleni. 

Nerve  to  the  rhomboidei,  from  the  5th  cervical,  passes  through 
scalenus  medius  to  the  base  of  the  scapula,  then  under  levator 
anguli  scapulae,  supplying  it,  and  ending  on  the  anterior 
surface  of  the  rhomboid  muscles. 

Nerve  to  the  subclavius,  from  the  trunk  formed  by  the  5th 
and  6th  cervical,  passes  downwards  in  front  of  the  3rd  part 
of  the  subclavian  artery  to  the  deep  surface  of  the  subclavius, 
often  communicates  with  phrenic. 

Communicating :  from  the  5th  to  join  the  phrenic  on  the 
scalenus  anticus. 

Posterior  thoracic,  or  external  respiratory  nerve  of  Bell : 
from  5th,  6th  and  yth,  pierces  scalenus  medius  and  then 
descends  behind  the  plexus  and  ist  part  of  axillary  artery 
nearly  to  the  lower  border  of  the  serratus  magnus,  which  it 
supplies. 

Supra-scapular:  from  the  union  of  the 5th  and  6th  cervical, 
passes  beneath  trapezius  to  upper  border  of  scapula,  enters 
supra-spinous  fossa  through  supra-scapular  notch,  gives  off 
two  branches  to  the  supra-spinatus,  and  an  articular  one  to 
the  shoulder-joint  ;  thence  it  passes  to  the  infra-spinous  fossa, 
and  ends  in  the  infra-spinatus. 

Branches  below  the  Clavicle  : — 

The  several  nerves  are  given  off  as  follows  : — 

Outer  Cord.  Inner  Cord.  Posterior  Cord. 

External  anterior  thoracic.        Internal  anterior  thoracic.  Subscapular. 

Musculo-cutaneous.  Lesser  internal  cutaneous.  Circumflex. 

Outer  head  of  median.  Internal  cutaneous.  Musculo-spiral. 

Ulnar. 

Inner  head  of  median. 

External  anterior  thoracic  (outer  cord) :  crosses  over 
axillary  artery  to  under  surface  of  the  pectoralis  major,  in 
which  it  communicates  with  internal  anterior  thoracic. 

Internal  anterior  thoracic  (inner  cord) :  passes  between 
axillary  artery  and  vein  to  the  two  pectoral  muscles. 

Subscapular  :  three  (posterior  cord). 

Upper  :  the  smallest,  perforates  upper  part  of  subscapularis. 

Lower :  ends  in  the  teres  major,  having  previously  given  a 
filament  to  the  subscapularis.  ' 

Middle  or  long :  runs  along  lower  border  of  subscapularis 
with  the  subscapular  vessels  to  supply  the  latissimus  dorsi. 

Circumflex  (posterior  cord)  :  passes  backwards  with  pos- 
terior circumflex  vessels  at  the  lower  border  of  the  sub- 
scapularis, through  quadrilateral  space  formed  by  teres  major, 


NERVES  163 

scapula,  long  head  of  the  triceps  and  humerus,  and,  having 
given  an  articular  branch  to  the  shoulder-joint,  divides  into — 

Anterior  branch  :  winds  round  neck  of  the  humerus,  supply- 
ing deltoid  and  skin. 

Posterior  branch  :  gives  a  branch  to  teres  minot,  which  has 
a  gangliform  swelling  upon  it ;  also  branches  to  deltoid  and 
integument. 

Cutaneous  appears  at  posterior  border  of  deltoid,  supplies 
skin  over  lower  §  of  muscle. 

Internal  cutaneous  (inner  cord)  :  lies  in  front  of  3rd  part 
of  axillary  artery,  becomes  cutaneous  about  middle  of  arm, 
and  divides  into  two  branches 

Anterior :  passes  behind  median  basilic  vein,  supplies  front 
of  inner  side  of  forearm  as  low  as  wrist. 

Posterior :  winds  over  internal  condyle,  supplying  the  back 
of  inner  side  of  forearm  to  about  the  middle. 

Lesser  internal  cutaneous  (nerve  of  Wrisberg)  (inner  cord) : 
lies  to  inner  side  of  axillary  vein,  communicates  with  the 
intercosto-humeral,  and  then  descends  along  inner  side  of 
brachial  vessels  to  middle  of  the  arm,  where  it  becomes 
cutaneous  and  supplies  integument  of  inner  side  as  far  as 
inner  condyle.  It  communicates  with  the  posterior  branch 
of  the  larger  internal  cutaneous. 

Musculp-cutaneous  (outer  cord) :  perforates  coraco-brachi- 
alis,  passing  to  outer  side  of  arm  between  biceps  and 
brachialis  anticus,  supplying  the  three  named  muscles ;  fila- 
ments also  are  given  to  the  elbow-joint ;  becomes  cutaneous 
just  above  elbow,  and,  passing  behind  median  cephalic  vein, 
divides  into — 

Anterior  cutaneous  branch:  passes  along  radial  border  of 
forearm,  supplying  ball  of  thumb  and  joining  the  radial. 

Posterior  cutaneous  branch :  supplies  integument  of  lower 
3rd  of  back  of  forearm  on  the  radial  side  ;  joins  branches  of 
radial  and  musculo-spiral  (external  cutaneous  branch). 

Median  :  arises  by  two  roots,  one  from  the  outer  cord,  the 
other  from  the  inner  cord  of  the  plexus,  which  cresses  3rd 
part  of  axillary  artery  to  join  the  outer  head.  At  first  the 
nerve  lies  to  the  outer  side  of  the  axillary  artery,  but  about 
the  middle  of  the  arm  it  crosses  the  brachial  artery  to  reach 
the  'inner  side ;  it  then  passes  between  the  two  heads  of 
the  pronator  radii  teres,  and  is  continued  straight  down 
the  forearm  upon  the  flexor  profundus,  and  beneath  the 
flexor  sublimis  ;  at  the  wrist  it  lies  between  the  tendons 
of  the  flexor  sublimis  and  flexor  carpi  radialis.  Passing 
beneath  the  annular  ligament,  it  becomes  somewhat 


1 64  THE  POCKET  ANATOMY 

flattened,  and  divides  into  two  parts  to  supply  the  outer 
31  fingers. 

Branches  in  the  Forearm  : — 

Articular:  to  elbow-joint. 

Muscular :  to  pronator  radii  teres,  flexor  carpi  radialis, 
palmaris  longus,  and  flexor  sublimis  digitorum. 

Anterior  interosseous :  is  given  off  just  below  the  elbow-joint. 
It,  passes  down  external  to  the  anterior  interosseous  artery 
on  the  membrane,  between  the  flexor  profundus  and  flexor 
longus  pollicis,  to  end  in  the  deep  surface  of  pronator  quad- 
ratus.  Supplies  flexor  longus  pollicis,  pronator  quadratus, 
and  outer  half  of  flexor  profundus  digitorum. 

Palmar  cutaneous  :  pierces  fascia  just  above  angular  ligament, 
ends  in  the  integument  of  the  palm,  joining  the  palmar 
cutaneous  of  the  ulnar  nerve. 

Terminal  branches  in  the  Hand : — 

Muscular  to  thumb  :  supplies  abductor,  opponens,  and  outer 
head  of  flexor  brevis  pollicis. 

Digital :  five  in  number,  supplying  outer  3^  fingers,  ist 
and  and  supply  the  thumb,  3rd  to  radial  side  of  index  finger 
also  supplies  ist  lumbrical;  4th  supplies  and  lumbrical 
and  adjacent  side  of  index  and  middle  fingers ;  5th  supplies 
adjacent  sides  of  ring  and  middle  fingers,  and  joins  a  branch 
of  the  ulnar,  giving  sometimes  a  branch  to  the  3rd  lumbrical. 

Ulnar  (inner  cord) :  passes  down  the  inner  side  of  axillary 
and  brachial  arteries  to  middle  of  arm  ;  it  then  runs  with 
inferior  profunda  artery  through  internal  intermuscular 
septum  to  groove  between  olecranon  and  internal  condyle. 
Thence  it  passes  through  the  two  heads  of  the  flexor  carpi 
ulnaris  and  descends  under  cover  of  that  muscle,  along  ulnar 
side  of  forearm  and  internal  to  ulnar  artery,  as  far  as  the 
pisiform  bone  ;  it  then  courses  over  the  annular  ligament 
external  to  that  bone,  and  divides  into  superficial  and  deep 
palmar  branches. 

Branches  in  the  Forearm  : — 

Articular  :  to  elbow  and  wrist  joints. 

Muscular :  to  flexor  carpi  ulnaris  and  inner  half  of  flexor 
profundus  digitorum. 

Cutaneous :  arises  near  middle  of  forearm,  and  divides  into: 
superficial  to  integument  of  forearm,  and  palmar,  accompanies 
ulnar  artery  to  hand,  supplying  the  palm :  joins  the 
cutaneous  of  median. 

Dorsal  cutaneous  :  comes  off  about  3  inches  above  pisiform 
bone,  winds  round  ulna  beneath  flexor  carpi  ulnaris,  supplies 
inner  side  of  little  finger,  and  adjacent  sides  of  ring  and  little 
fingers  on  the  dorsal  aspect. 


NER  VES  165 

Palmar  branches  • — 

Superficial :  supplies  palmaris  brevis,  ends  in  two  digital 
branches  for  inner  i£  fingers  the  outer  one  communicating 
with  the  median. 

Deep :  accompanies  deep  palmar  arch ;  it  supplies  the  small 
muscles  of  the  5th  finger,  and  gives  two  branches  to  each 
interosseous  space,  one  for  each  set  of  interossei ;  branches 
are  also  given  to  the  two  inner  lumbrical  muscles.  In  the 
space  between  the  thumb  and  index  finger  the  nerve  ends  by 
supplying  the  adductor  obliquus,  adductor  transversus,  and 
inner  head  of  the  flexor  brevis  pollicis. 

Musculo-spiral  (posterior  cord) :  winds  round  between  outer 
and  inner  heads  of  triceps  in  the  musculo-spiral  groove  with 
superior  profuncla  artery  to  the  outer  side  of  arm.  Piercing 
the  external  intermuscular  septum,  it  passes  to  the  external 
condyle  between  the  supinator  longus  and  brachialis  anticus, 
where  it  divides  into  radial  and  posterior  interosseous  nerves. 

Branches  in  the  Arm  : — 

Muscular :  to  the  three  heads  of  the  triceps,  to  the  anconeus, 
supinator  longus,  extensor  carpi  radialis  longior,  and  brachialis 
anticus. 

Cutaneous :  Internal,  comes  off  near  axilla,  supplies  integu- 
ment on  back  of  arm  to  near  olecranon.  External  (2),  upper 
one  perforates  outer  head  of  triceps,  accompanies  cephalic 
vein  to  elbow,  supplying  the  integument  of  the  lower  half  of 
arm  in  front.  Lower  one  supplies  integument  of  lower  part 
of  arm,  and  back  part  of  radial  side  of  forearm  as  far  as  the 
wrist. 

Terminal  branches : — 

Radial :  passes  down  by  outer  side  of  radial  artery,  under 
cover  of  the  supinator  longus,  till  within  3  inches  of  the  lower 
end  of  the  radius,  where  the  nerve  passes  backwards  beneath 
the  tendon  of  the  supinator  longus,  and,  becoming  cutaneous 
by  piercing  the  fascia  on  outer  side  of  forearm,  divides  into 
two  branches : — 

External :  supplies  ball  and  outer  border  of  thumb,  joining 
with  the  external  cutaneous  nerve. 

Internal :  joins  a  branch  of  the  external  cutaneous  and 
dorsal  of  ulnar.  It  gives  off  four  dorsal  digital  nerves,  thus : 
ist  to  inner  side  of  thumb,  2nd  to  outer  side  of  index,  3rd  to 
adjacent  sides  of  index  and  middle,  4th  to  adjacent  sides  of 
middle  and  ring  fingers.  It  thus  corresponds  in  its  distribu- 
tion with  the  median  nerve. 

Posterior  interosseous  :  reaches  the  back  of  the  forearm  by 
piercing  the  supinator  brevis  ;  there  it  passes  between  the 
superficial  and  deep  layers  of  muscles  to  about  middle  of 


1 66  THE  POCKET  ANATOMY 

forearm,  where  it  passes  deep  to  extensor  longus  pollicis  to 
reach  the  interosseous  membrane,  on  which  it  lies,  as  far  as 
the  wrist ;  it  there  ends  in  a  gangliform  enlargement,  from 
which  there  are  given  off  filaments  to  the  ligaments,  etc. 
Supplies  supinator  brevis,  extensores  carpi  radialis  brevior, 
communis  digitorum,  minimi  digiti,  carpi  ulnaris,  ossis  meta- 
carpi  pollicis,  longus  and  brevis  pollicis,  and  indicis. 

NERVES  OF  THE  TRUNK. 

DORSAL  :  twelve  in  number.  The  ist  comes  out  between 
the  ist  and  and  dorsal  vertebrae,  and  the  greater  part  joins 
the  brachial  plexus.  The  last  nerve  emerges  from  between 
the  i ath  dorsal  and  ist  lumbar  vertebrae.  Each  nerve  at  its 
exit  from  the  intervertebral  foramen  divides  into  an  anterior 
and  posterior  primary  division.  The  ist  and  I2th  nerves, 
however,  require  a  separate  description. 

The  POSTERIOR* PRIMARY  DIVISIONS,  or  dorsal  branches, 
pass  backwards  between  the  transverse  processes  and  divide 
into  external  and  internal  branches,  which  emerge  on  either 
side  of  the  middle  division  of  the  erector  spinse  (longissimus 
dorsi),  and  supply  the  muscles  of  the  back.  Cutaneous  branches 
are  derived  from  each  of  these  sets,  the  six  upper  ones  coming 
from  the  internal  branches  and  the  six  lower  ones  from  the 
external  branches. 

The  ANTERIOR  PRIMARY  DIVISIONS,  or  intercostal  nerves,  are 
twelve  in  number  on  each  side  ;  each  communicates  with  the 
corresponding  ganglion  of  the  sympathetic  chain. 

The  UPPER  six  pass  forwards  in  the  intercostal  spaces 
below  the  vessels,  lying  at  first  between  the  pleura  and 
external  intercostal  muscle,  then  between  the  external  and 
internal  intercostal  muscles ;  after  giving  off  the  lateral 
cutaneous  branches,  they  lie  in  the  internal  intercostal  muscle, 
and  then  between  that  muscle  and  pleura,  extending  forwards 
to  the  sternum,  and  crossing  the  internal  mammary  artery,  to 
end  as  the  anterior  cutaneous  nerves  of  the  thorax  by  perforating 
internal  intercostal  and  pectoralis  major. 

Branches : — 

Lateral  cutaneous :  given  off  midway  between  head  of  rib 
and  sternum.  .The  ist  intercostal  nerve  has  generally  no 
lateral  cutaneous  branch.  Each  branch,  except  that  from  the 
2nd  nerve,  then  pierces  the  external  intercostal  muscle,  and 
divides  into  anterior  and  posterior  branches,  which  supply 
the  muscles,  mammary  gland,  and  integument. 

The  lateral  cutaneous  branch  of  the  2nd  nerve,  or  intercosto- 


NER  VES  167 

humeral,  has  no  anterior  branch  ;  the  posterior  branch  crosses 
the  axilla,  joins  the  lesser  internal  cutaneous  nerve,  and 
supplies  the  integument  of  the  inner  side  of  the  arm. 

The  LOWER  six  pass  like  the  upper  ones  to  the. front  of  the 
intercostal  spaces,  thence  between  the  internal  oblique  and 
transversalis  to  the  sheath  of  the  rectus,  which  they  perforate, 
and  terminate  near  the  middle  line  as  anterior  cutaneous  branches 
of  the  abdominal  wall. 

Branches : — 

Lateral  cutaneous:  supply  the  integument  of  the  abdomen, 
having  anterior  and  posterior  branches. 

PECULIAR  DORSAL  NERVES  :  The  ist  nerve :  its  anterior 
primary  division  is  mostly  consumed  in  the  brachial  plexus, 
but  a  small  branch  is  given  off  to  the  ist  intercostal  space, 
which  has  no  lateral  cutaneous  branch.  The  i2th  nerve  does 
not  lie  in  an  intercostal  space,  but  below  the  I2th  rib  in  front 
of  the  quadratus  lumborum ;  it  then  pierces  the  posterior 
aponeurosis  of  the  transversalis,  passing  forwards  between 
transversalis  and  internal  oblique  to  end  by  perforating  rectus ; 
is  remarkable  for  the  large  size  of  its  lateral  cutaneous  branch, 
which  does  not  divide,  but,  piercing  internal  and  external 
obliques,  passes  over  iliac  crest  and  supplies  skin  over  gluteal 
region  as  far  down  as  great  trochanter. 

LUMBAR  :  five  on  each  side.  The  ANTERIOR  PRIMARY  DIVI- 
SIONS increase  in  size  from  above  downwards,  and  near  their 
origin  communicate  with  the  sympathetic  ganglia,  the  upper 
four  forming  the  lumbar  plexus ;  that  of  the  5th  joins  with 
the  ist  sacral  to  form  the  lumbo-sacral  cord.  The  POSTERIOR 
PRIMARY  DIVISIONS  pass  backwards  between  the  transverse 
processes  and  divide  into  internal  and  external  branches. 
These  are  seen  to  be  separated  by  the  longissimus  dorsi. 
The  internal  branches  end  in  the  muscles,  and  all  the  external 
gjve  muscular  branches;  the  upper  three  also  give  cutaneous 
branches  to  gluteal  region. 


NERVES  OF  THE  LOWER  EXTREMITY. 

LUMBAR  PLEXUS  :  formed  in  the  psoas  by  the  communica- 
tions of  the  anterior  primary  divisions  o£  the  four  upper 
lumbar  nerves  in  the  following  manner : — 

The  ist  gives  off  the  ilio-hypogastric,  the  ilio-inguinal,  a 
branch  to  the  genito-crural,  and  a  communicating  branch  to 
the  1 2th  dorsal  and  2nd  lumbar. 

The  2nd  gives  off  branches  to  the  genito-crural,  and  external 


168  THE  POCKET  ANATOMY 

cutaneous,  and  a  communicating  branch  to  the  3rd,  which 
also  forms  part  of  the  anterior  crural  and  obturator. 

The  3rd  gives  off  part  of  the  external  cutaneous,  of  the 
anterior  crural,  and  of  the  obturator. 

The  4th  gives  off  a  branch  to  the  anterior  crural,  one  to  the 
obturator,  and  a  communicating  one  to  the  5th. 

Muscular  branches  are  also  supplied  to  the  psoas  and  quad- 
ratus  lumborum. 

BRANCHES    OF    THE    LUMBAR    PLEXUS. 

Ilio-hypogastric  :  from  ist  lumbar,  appears  at  upper  part  of 
outer  border  ot  psoas,  crosses  quadratus  lumborum  to  iliac 
crest,  and,  piercing  the  trans versalis,  divides  into: — 

Iliac  branch:  pierces  two  oblique  muscles,  crosses  iliac  crest 
behind  lateral  cutaneous  of  last  dorsal  to  integument  of 
buttock. 

Hyfiogastric  branch :  pierces  internal  oblique  and  then  ex- 
ternal oblique  aponeurosis  above  abdominal  ring  to  integument 
of  hypogastric  region. 

Ilio-inguinal :  from  ist  lumbar ;  passes  over  quadratus 
lumborum  and  iliacus  to  iliac  crest,  pierces  the  transversalis 
and  internal  oblique ;  it  then  accompanies  the  cord  through 
canal  and  external  ring,  and  is  distributed  to  the  integument 
of  the  groin  and  the  scrotum. 

Genito-crural :  from  2nd  lumbar,  with  a  branch  from  ist. 
Passes  on  the  psoas  to  Poupart's  ligament  to  divide  into : — 

Genital  branch :  crosses  external  iliac,  enters  inguinal  canal 
through  internal  abdominal  ring,  accompanies  spermatic  cord, 
and  supplies  the  cremaster  muscle.  In  the  female  it  accom- 
panies the  round  ligament  of  the  uterus. 

Cmral  branch :  passes  beneath  Poupart's  ligament,  perforates 
fascia  on  outer  side  of  femoral  artery,  communicates  with 
middle  cutaneous  nerve,  supplies  integument  of  upper  and 
front  of  thigh. 

External  cutaneous :  from  loop  between  2nd  and  3rd  lumbar ; 
perforates  middle  of  outer  border  of  psoas,  and  enters  thigh 
just  below  anterior  superior  iliac  spine,  where  it  divides 
into : — 

Anterior  branch:  contained  at  first  in  a  tube  of  the  fascia 
lata ;  supplies  outer  part  of  anterior  surface  of  thigh. 

Posterior  branch :  supplies  outer  surface  of  thigh  to  the  middle. 

Obturator :  from  2nd,  3rd,  and  4th  lumbar ;  passes  from 
inner  border  of  psoas,  near  brim  of  pelvis  and  above  obturator 
artery,  but  below  external  iliac,  to  canal  in  upper  part  of 
thyroid  foramen.  In  this  canal  it  divides  into  : — 


NERVES  169 

Anterior  or  superficial  part:  descends  in  front  of  adductor 
brevis,  behind  pectineus  and  adductor  longus ;  it  supplies  the 
hip-joint,  gracilis,  adductor  longus,  adductor  brevis,  femoral 
artery,  and  a  branch  to  plexus  near  sartorius ;  rarely  the 
pectineus ;  communicates  with  accessory  obturator  when  this 
is  present. 

Posterior  or  deep  part:  passes  through  obturator  externus 
and  behind  adductor  brevis ;  it  supplies  a  large  branch  to 
adductor  magnus,  and  gives  branches  also  to  obturator  ex- 
ternus, adductor  brevis  when  this  latter  is  not  supplied  by 
the  anterior  branch,  and  a  branch  along  popliteal  artery  to 
knee-joint. 

Accessory  obturator :  from  3rd  and  4th  lumbar  or  from 
obturator  trunk ;  when  present  it  passes  down  on  inner  side 
of  psoas,  over  horizontal  ramus  of  pubes,  under  pectineus, 
and  supplies  pectineus  and  hip-joint ;  communicates  with  the 
anterior  branch  of  the  obturator. 

Anterior  crural :  from  3rd  and  4th,  and  partly  from  the 
2nd  lumbar ;  emerges  from  lower  part  of  outer  border  of 
psoas,  and  descends  between  that  muscle  and  the  iliacus, 
lying  on  the  outer  side  of  the  iliac  vessels.  It  supplies  the 
iliacus  and  femoral  artery  whilst  in  the  pelvis,  and  on  emerging 
from  it  beneath  Poupart's  ligament,  it  divides  into  : — 

Anterior  or  superficial  portion  :  which  gives  off : — 

Middle  cutaneous :  pierces  fascia  lata  3  inches  below  Poupart's 
ligament,  dividing  into  two  branches  to  supply  the  integument 
of  the  front  of  the  thigh  as  far  as  the  knee.  Communicates 
with  crural  of  genito-crural  and  internal  cutaneous,  and  gives 
a  branch  to  the  sartorius. 

Internal  cutaneous :  passes  obliquely  across  to  inner  side  of 
femoral  artery,  and  divides  into:  Anterior  branch:  pierces 
fascia  lata  in  lower  J  of  thigh  ;  supplies  integument  of  the 
lower  £  of  inner  side  of  thigh ;  communicates  near  the 
knee  with  -long  saphenous.  Posterior  branch  :  passes  down 
posterior  border  of  sartorius  to  knee,  giving  branches  to 
plexus  near  that  muscle,  and  finally  is  distributed  to  integu- 
ment of  the  leg;  communicates  in  the  thigh  with  the  obturator 
and  the  internal  saphenous  nerves,  forming  in  Hunter's  canal 
a  plexiform  interlacement,  the  subsartorial plexus. 

Nerve  to  pectineus :  generally  two,  which  pass  inwards  under 
femoral  vessels  to  muscle. 

Nerves  to  sartorius  :  given  off  with  middle  cutaneous. 

Plexus  patella :  the  patellar  plexus  is  formed  by  communica- 
tions between  the  anterior  branch  of  the  internal  cutaneous, 
branches  of  the  middle  and  external  cutaneous  nerves,  together 


i yo  THE  POCKET  ANATOMY 

with  the  patellar  branch  of  the  internal  or  long  saphenous 
nerve. 

Deep  or  posterior  part :  which  gives  off : — 

Internal  or  long  saphenous  :  accompanies,  lying  on  outer  side 
of,  femoral  vessels  as  far  as  Hunter's  canal,  where  it  crosses, 
artery,  and  leaves  it  at  opening  in  adductor  magnus  by  passing 
inwards  beneath  sartorius.  Here  it.  becomes  subcutaneous, 
and  is  continued  with  the  internal  saphenous  vein  along  inner 
side  of  leg,  behind  inner  border  of  tibia,  and,  passing  in  front 
of  inner  ankle,  is  distributed  on  inner  side  of  foot  as  far  as 
ball  of  great  toe.  In  its  course  it  gives  off  a  branch  to  plexus 
under  sartorius  formed  by  obturator  and  internal  cutaneous 
nerves,  to  patellar  plexus,  and  below  the  knee  to  the  integu- 
ment on  the  anterior  and  inner  surfaces  of  the  leg. 

Muscular. — To  the  rectus,  which  gives  branch  to  hip-joint. 

To  the  vastus  externus,  which  gives  an  articular  branch  to  the 
knee-joint,  and  accompanies  descending  branch  of  the  external 
circumflex  artery. 

To  the  vastus  internus,  which  gives  off  an  articular  branch  to 
the  knee-joint,  and  accompanies  the  deep  branch  of  the 
anastomotica  magna  artery. 

To  crureus,  two  or  three,  the  internal  one  supplying  sub- 
crureus  and  knee-joint. 

SACRAL  NERVES,  five  in  number.  The  roots  of  origin  form 
the  cauda  equina,  and  in  this  region  t.he  posterior  root  ganglia 
are  placed  inside  the  spinal  canal,  though  outside  the  dura 
mater.  Each  nerve  divides  into  anterior  and  posterior  primary 
branches. 

The  posterior  primary  branches  of  the  upper  four  emerge 
from  the  posterior  sacral  foramina,  the  fifth  at  the  lower  end 
of  the  spinal  canal ;  the  upper  three  nerves  divide  into  internal 
and  external  branches,  the  former  supplying  the  multifidus 
spinae,  the  latter  the  integument  over  sacrum,  coccyx,  and 
posterior  gluteal  region  ;  the  two  lower  nerves  do  not  divide, 
and  supply  filaments  to  integument  over  coccyx,  the  5th  com- 
municating with  the  coccygeal. 

COCCYGEAL  NERVE  :  this  nerve  divides  into  an  anterior 
branch,  which  pierces  sacro-sciatic  ligament  and  coccygeus, 
supplies  integument  over  coccyx,  and  communicates  with  the 
5th  sacral,  forming  part  of  ano-coccygeal  plexus ;  and  a 
posterior,  to  supply  coccygeal  integument. 

The  ANTERIOR  PRIMARY  BRANCHES  decrease  in  size  from 
above  downwards.  The  upper  four  issue  from  the  anterior 
sacral  foramina,  the  5th  emerging  between  sacrum  and  coccyx. 
Each  nerve  communicates  with  the  sympathetic.  The  first 


NERVES  171 

three  and  part  of  the  4th  nerves  enter  the  sacral  plexus,  whilst 
the  lower  part  of  the  4th,  the  5th,  and  the  coccygeal  nerve 
form  a  small  plexus,  ano-coccygeal,  which  lies  on  the  pelvic 
surface  of  the  coccygeus. 

The  ano-coccygeal  plexus  :  formed  as  described  above. 
Branches : — 
Muscular  to : — 
Coccygeus. 
Levator  ani. 
Sphincter  ani  externus  (usually  called  the  perinea) 

branch  of  the  4th  sacral). 
Visceral. 
Vesical. 
Rectal. 

Vaginal  (in  female). 

Cutaneous  :  perforating  cutaneous  of  4th  sacral  to  integu- 
ment over  coccyx. 

The  SACRAL  PLEXUS  is  formed  by  the  lumbo-sacral  cord 
(p.  167),  anterior  primary  branches  of  the  upper  three  and 
part  of  that  of  the  4th  sacral  nerves.    Lies  on  anterior  surface 
of  pyriformis,  behind  the  sciatic  and  internal  pudic  arteries. 
Branches : — 
Muscular:  To  pyriformis,  from  ist  and  and. 

To  obturator  internus  and  gemellus  superior, 
from  5th  lumbar,  ist  and  2nd  sacral,  emerges 
from  pelvis  through  great  sacro-sciatic  foramen, 
winds  over  ischial  spine  outside  the  internal  pudic 
artery,  passes  in  through  small  sacro-sciatic 
foramen  to  inner  surface  of  muscle,  having  first 
supplied  superior  gemellus. 

To  quadratus  femoris  and  gemellus  inferior, 
given  off  from  lumbo-sacral  cord  and  ist  sacral, 
passes  anterior  to  gemelli  and  obturator  internus 
tendon  to  anterior  surface  of  quadratus,  giving 
on  its  way  a  branch  to  gemellus  inferior,  and  an 
articular  branch  to  the  hip-joint. 

Superior  gluteal :  from  lumbo-sacral  cord  and  ist  sacral, 
passes  out  of  great  sacro-sciatic  foramen,  above  the  pyriformis, 
with  the  gluteal  vessels ;  divides  into  a  superior  branch,  which 
passes  between  the  two  smaller  glutei,  supplying  the  medius, 
and  an  inferior  branch,  supplying  the  gluteus  minimus  and  the 
tensor  fasciae  femoris. 

Pudic  :  comes  off  from  the  2nd,  3rd,  and  4th  nerves,  passes 
out  of  great  sacro-sciatic  notch  between  pyriformis  and 
coccygeus  internal  to  great  sciatic  nerve,  winds  over  ischial 


172  THE  POCKET  ANATOMY 

spine  internal  to  pudic  artery,  and  re-enters  pelvis  through 
the  small  notch  lying  on  inner  side  of  internal  pudic  artery ; 
it  then  enters,  with  accompanying  vessels,  a  sheath  of  the 
obturator  fascia  in  the  outer  wall  of  the  ischio-rectal  fossa 
and  divides  into  its  three  branches. 

Branches : — 

Inferior  h&morrhoidal :  crosses  ischio-rectal  fossa  to  supply 
external  sphincter,  skin  of  anus  ;  communicates  with  inferior 
pudendal  of  small  sciatic  and  superficial  perineal  nerves. 

Perineal :  largest  terminal  branch,  accompanies  perineal 
artery,  and  divides  into  : 

Cutaneous  or  superficial  perineal,  two  in  number :  the  internal 
passes  with  superficial  perineal  artery  either  under  or  over 
the  transversus  perinaei  to  supply  the  scrotum  ;  the  external 
gives  a  branch  to  the  anus,  and,  piercing  the  deep  layer  of 
the  superficial  fascia,  supplies  the  scrotum,  joining  the  inferior 
pudendal. 

Muscular  branches  supply  transversus  perinaei,  erector  penis, 
ejaculator  urinas,  compressor  urethras,  sphincter  and  levator 
ani. 

Nerve  to  bulb :  pierces  ejaculator  urinaa  and  supplies 
bulb. 

Dorsal  nerve  of  the  penis  :  accompanies  internal  pudic  artery 
between  the  layers  of  the  triangular  ligament  lying  on  the 
outer  side  of  the  artery,  pierces  the  anterior  layer  of  the  liga- 
ment, and  the  suspensory  ligament  to  reach  dorsum  of  penis, 
along  which  it  runs  as  far  as  the  glans,  gives  off  many  branches 
to  supply  the  organ,  and  joins  branches  of  the  sympathetic. 
In  the  female  this  nerve  is  distributed  to  the  clitoris. 

Inferior  gluteal :  from  the  lumbo-sacral  cord,  ist  and  2nd 
sacral  nerves  ;  passes  out  of  pelvis  below  the  pyriformis,  at 
the  lower  border  of  which  it  turns  backwards,  and,  dividing 
into  numerous  branches,  enters  deep  surface  of  gluteus 
maximus.  Communicates  near  origin  with  the  small  sciatic. 

Small  sciatic  :  a  cutaneous  nerve  to  lower  part  of  buttock 
and  back  of  thigh ;  it  comes  off  from  2nd  and  3rd  sacral  nerves. 
It  passes  below  the  pyriformis  with  the  sciatic  artery,  and  runs 
down  the  back  of  the  thigh  beneath  the  gluteus  maximus,  and 
below  this  beneath  the  fascia  lata,  which  it  pierces  in  the 
popliteal  space. 

Branches : — 

Internal  cutaneous ;  to  integument  of  upper  and  inner  side  of 
thigh :  one  larger  one,  the  inferior  pitdendal,  turnj  inwards 
over  hamstrings,  supplies  scrotum,  and  joins  the  external 
superficial  perineal  nerve. 


NERVES  173 

External  cutaneous  :  winds  round  ghueus  maximus,  supplies 
the  integument  over  lower  part  of  buttock. 

Terminal:  to  integument  of  thigh,  popliteal  region,  and 
calf  of  leg. 

GREAT  SCIATIC  :  the  largest  nerve  in  the  body,  and  is  the 
main  continuation  of  the  sacral  plexus,  lies  in  pelvis  on  pyri- 
formis  ;  it  is  derived  from  the  lumbo-sacral  cord,  the  ist,  2nd, 
and  3rd  sacral  nerves.  It  passes  out  of  pelvis  below  the 
pyrifoimis,  and  between  the  tuber  ischii  and  great  trochanter. 
resting  upon  the  gemelli,  obturator  internus,  quadratus 
femoris,  and  adductor  magnus.  It  is  at  first  external  to  the 
biceps,  then  between  its  two  heads  of  origin,  finally  between 
it  and  semi-membranosus,  and  is  accompanied  by  the  sciatic 
artery,  which  supplies  a  branch  to  its  substance  (comes  nervi 
ischiadici).  At  a  variable  distance  between  the  sacral  plexus 
and  lower  part  of  the  thigh,  but  generally  about  the  middle 
of  the  thigh,  the  nerve  bifurcates  into  external  and  internal 
popliteal. 

Branches  of  the  Trunk  : — 

Muscular :  given  off  under  biceps  to  semi-membranosus, 
semi-tendinosus,  both  heads  of  biceps,  and  to  the  inner  part 
of  adductor  magnus. 

INTERNAL  POPLITEAL:  larger  terminal  branch,  passes  along 
middle  of  popliteal  space  to  lower  border  of  popliteus,  where 
it  gets  the  name  of  posterior  tibial;  it  is  at  first  superficial  to 
and  outside  the  artery,  but  at  the  lower  end  of  the  space, 
under  the  gastrocnemius,  crosses  to  the  inner  side. 

Branches  : — 

Articular  (3)  :  one  accompanies  each  of  the  upper  and 
lower  internal  articular  arteries,  the  third  the  azygos. 

Muscular  :  to  the  gastrocnemius,  one  for  each  head,  the  outer 
one  supplying  also  the  plantaris.  To  the  soleus  and  to  the 
Popliteus ;  the  nerve  to  the  latter  turns  round  lower  border  of 
muscle  and  enters  it  upon  its  anterior  surface. 

Tibial  communicating :  passes  down  leg  superficially  between 
two  heads  of  the  gastrocnemius,  pierces  the  deep  fascia  about 
middle  of  leg,  there  joining  the  peroneal  communicating  from  the 
external  popliteal,  and  is  now  known  as  the  external  or  short 
saphenous  nerve  ;  it  then  follows  the  course  of  the  external 
saphenous  vein  round  outer  malleolus,  and  supplies  integu- 
ment of  outejr  side  of  foot  and  little  toe,  communicating  with 
the  musculo-cutaneous  on  the  dorsum. 

POSTERIOR  TIBIAL  (continuation  of  internal  popliteal): 
begins  at  the  lower  border  of  the  popliteus,  and  runs  with 


174  THE  POCKET  AN  ATOM? 

the  posterior  tibial  vessels  to  interval  between  the  external 
malleolus  and  heel,  where  it  divides  into  external  and  internal 
plantar.    It  is  at  first  inside  the  artery,  but  afterwards  crosses 
to  the  outer  side. 
Branches : — 

Kluscular :  to  soleus,  tibialis  posticus,  flexor  longus  digi- 
torum,  and  flexor  longus  hallucis,  the  latter  accompanying 
the  peroneal  artery. 

Internal  calcanean :  pierces  internal  annular  ligament,  to 
supply  integument  of  heel  and  inner  side  of  sole  of  foot. 

Internal  plantar :  larger  terminal  branch  of  the  posterior 
tibial ;  accompanies  internal  plantar  artery  along  inner  side 
of  foot :  the  larger  nerve  thus  accompanies  the  smaller  artery. 
Corresponds  in  distribution  to  median  nerve  of  hand.  It 
passes  between  the  abductor  hallucis  and  flexor  brevis  digi- 
torum  to  divide  opposite  the  bases  of  the  metatarsal  bones 
into  four  branches,  the  outermost  of  which  communicates 
with  the  external  plantar. 
Branches  : — 

Cutaneous :  to  sole  of  foot. 

Muscular:  to  abductor  hallucis  and  flexor  brevis  digi- 
torum. 

Articular :  to  tarsal  and  metatarsal  articulations. 
Digital  (4) :  the  ist  supplies  inner  border  of  ist  toe  and  the 
flexor  brevis  hallucis,  the  2nd  supplies  the  adjacent  sides  of 
the  ist  and  2nd  toes  and  the  ist  lumbrical,  the  3rd  supplies 
the  adjacent  sides  of  the  2nd  and  3rd  toes,  and  the  4th  supplies 
the  adjacent  sides  of  the  3rd  and  4th  toes  and  joins  a  branch 
from  the  external  plantar. 

External  plantar  :  passes  across  to  outer  side  of  foot  with 
external  plantar  artery,  supplying  on  its  way  the  abductor 
minimi  digiti  and  flexor  accessorius  ;  at  the  outer  border  of 
the  latter  muscle  it  divides  into  two  branches  : — 

Superficial :  which  divides  into  two  digital  nerves,  one  sup- 
plying the  outer  side  of  the  little  toe,  the  flexor  brevis  minimi 
digiti,  and  the  two  interossei  of  the  4th  space  ;  the  other 
supplies  the  adjacent  sides  of  the  4th  and  5th  toes  and  com- 
municates with  the  internal  plantar. 

Deep  or  muscular:  accompanies  deep  part  of  external 
plantar  artery,  supplying  the  adductor  obliquus  hallucis, 
adductor  transversus  Jhallucis,  three  outer  lumbricals  and 
interossei  of  inner  three  spaces. 

EXTERNAL  POPLITEAL  OR  PERONEAL  :  passes  along  the 
popliteal  space  under  cover  of  and  inside  biceps  tendon, 
then  over  outer  head  of  gastrocnemius  to  the  fibula ; 


NERVES  175 

i  inch  below  head  of  that  bone  it  pierces  the  peroneus  longus, 
and  in  that  muscle  divides  into  anterior  tibial  and  musculo- 
cutaneous  nerves. 

Branches : — 

Articular  (2)  :  generally  given  off  together,  accompany 
superior  and  inferior  external  articular  arteries. 

Cutaneous :  supply  integument  of  back  and  outer  side  of 
leg  in  upper  third. 

Peroneal  or  fibular  communicating  :  arises  close  to  head  of 
fibula  and  joins  the  tibial  communicating,  the  two  forming 
the  short  saphenous  nerve. 

Anterior  tibial :  passes  to  front  of  interosseous  membrane 
by  piercing  extensor  longus  digitorum  to  reach  outer  side  of 
anterior  tibial  artery,  with  which  it  descends  to  the  ankle- 
joint,  where  it  bifurcates  into  an  internal  and  external 
branch  ;  it  lies  in  middle  J  of  leg,  in  front  of  artery,  and 
in  lowest  ^,  again,  outside  it. 

Branches  : — 

Recurrent  articular:  sends  a  branch  to  knee,  which  accom- 
panies anterior  tibial  recurrent  artery  to  joint. 

Muscular :  to  tibialis  anticus,  extensor  longus  digitorum, 
peroneus  tertius,  and  extensor  proprius  hallucis. 

External  or  tarsal :  passes  outwards  beneath  the  extensor 
brevis  digitorum  and  becomes  ganglionic,  supplies  the  extensor 
brevis,  and  the  articulations  of  the  tarsus  and  metatarsus. 

Internal:  accompanies  dorsalis  pedis  to  ist  interosseous 
space,  lying  outside  it,  supplies  adjacent  sides  of  ist  and  2nd 
toes,  communicating  with  the  musculo-cutaneous. 

Musculo-cutaneous  :  supplies  peroneus  longus  and  brevis, 
and  dorsal  integument  of  foot.  It  passes  down  between 
peronei  and  the  long  extensor  of  toes,  piercing  deep  fascia  at 
lower  £  of  leg. 

Branches : — 

Muscular  :  to  peroneus  longus  and  peroneus  brevis. 

Cutaneous :  to  lower  part  of  leg. 

Internal:  passes  over  ankle  to  inner  side  of  ist  toe  and 
adjacent  sides  of  2nd  and  3rd  toes,  communicates  with  internal 
saphenous  and  anterior  tibial  nerves. 

External :  supplies  adjoining  sides  of  3rd,  4th,  and  5th  toes; 
communicates  with  short  saphenous. 

SYMPATHETIC    NERVES 
The  sympathetic  system  consists  of — 

1.  The  great  gangliated  cords. 

2.  The  prevertebral  plexuses,  and  branches  proceeding 

from  them. 


176  THE  POCKET  ANATOMY 

3.  Ganglia  of  union  with  cranial  nerves — viz.,  ophthal- 
mic, spheno-palatine,  otic,  and  submaxillary.  These 
have  been  described  with  the  5th  nerve. 

THE  GREAT  GANGLIATED  CORDS, 

two  in  number,  extend  the  whole  length  of  the  vertebral 
column.  They  consist  of  ganglia,  united  by  intervening 
cords,  and  are  placed  partly  in  front  and  partly  by  the  side 
of  the  vertebras.  Above  they  are  connected  with  two  plexuses 
entering  the  cranium,  and  below  they  join  together  in  a  loop 
over  the  coccyx.  The  parts  of  the  cords  are  named  accord- 
ing to  the  region  they  occupy — viz.,  cervical,  dorsal,  lumbar, 
and  sacral.  The  cervical  portion  has  three  ganglia,  whilst  in 
the  rest  of  its  extent  each  cord  contains  ganglia  equal  in 
number  to  the  vertebrae. 

Each  ganglion  is  connected  with  the  anterior  primary  division 
of  the  corresponding  spinal  nerve  by  an  afferent  (white) 
filament,  and  an  efferent  (grey)  connecting  branch.  The 
interganglionic  cords  are  composed  of  white  and  grey  fibres, 
the  former  being  continuous  with  the  filaments  from  the 
spinal  nerves. 

The  CERVICAL  PART  of  the  gangliated  cord  lies  behind  the 
carotid  sheath,  just  in  front  of  the  prevertebral  muscles,  and 
contains  three  ganglia. 

i.  The  SUPERIOR  CERVICAL  GANGLION  lies  on  the  rectus 
capitis  anticus  major  behind  carotid  sheath,  opposite  the  and 
and  3rd  cervical  vertebras. 

Branches : — 

Connecting  :  with  the  anterior  primary  divisions  of  ist,  2nd, 
3rd,  and  4th  cervical  nerves  :  with  the  ganglion  of  trunk  and 
the  ganglion  of  the  root  of  the  pneumogastric,  with  the  hypo- 
glossal,  with  the  petrous  ganglion  of  the  glosso-pharyngeal. 

Pharyngeal  nerves  and  plexus  :  the  pharyngeal  nerves  are 
given  off  from  the  front  of  the  superior  cervical  ganglion,  and 
pass  forwards  and  downwards.  They  join  with  branches 
from  the  pneumogastric  and  glosso-pharyngeal  nerves  forming 
the  pharyngeal  plexus,  which  lies  on  the  middle  constrictor 
muscle.  Branches  from  the  plexus  supply  the  constrictors, 
levator  palati,  palato-glossus,  palato-pharyngeus,  andazygos 
uvulae  muscles :  the  motor  fibres  are  derived  from  the 
bulbar  part  of  spinal  accessory,  and  reach  plexus  through 
pharyngeal  branch  of  vagus. 

The  upper  cardiac  nerves :  the  right  upper  cardiac  nerve 
comes  off  by  two  roots  from  the  upper  cervical  ganglion.  It 
passes  downwards  behind  the  carotid  sheath,  but  in  front  of 
the  inferior  thyroid  artery  and  recurrent  laryngeal  nerve.  It 


NERVES  177 

then  goes  either  behind  or  in  front  of  the  subclavian  artery, 
and,  coursing  along  the  innominate,  ends  in  the  deep  cardiac 
plexus  behind  the  arch  of  the  aorta.  In  the  middle  of  the 
neck  it  communicates  with  the  external  laryngeal,  lower  down 
with  the  upper  cardiac  branches  of  the  pneumogastric,  in  the 
thorax  with  the  recurrent  laryngeal,  and  with  other  sympa- 
thetic branches  in  its  whole  course. 

The  left  upper  cardiac  nerve  has  the  same  connections  in  the 
neck  as  the  right  nerve.  On  entering  the  thorax,  it  passes 
along  left  common  carotid  artery,  and,  crossing  the  arch  of 
the  aorta,  joins  the  superficial  cardiac  plexus. 

Branches  to  Vessels. — Branches  are  given  to  the  external 
carotid  artery,  which  are  prolonged  to  its  branches. 

Ascending  or  carotid  branch  lies  behind  internal  carotid 
artery,  enters  carotid  canal,  and  divides  into: — 

(a)  External  division :    distributed   to    internal    carotid ; 

communicates  with  tympanic  branch  of  glosso- 
pharyngeal,  and  forms  the  carotid  plexus. 

(b)  Internal  division :  distributed   over    internal    carotid 

artery,  thus  communicating  with  the  external 
division,  and  prolonged  to  form  the  cavernous 
plexus. 

The  carotid  plexus  lies  on  the  outer  side  of  the  internal 
carotid  artery  at  its  2nd  bend. 

Branches  : — 

Connecting  :  to  the  6th  nerve  and  Gasserian  ganglion. 

The  large  deep  petrosal  nerve  passes  from  the  plexus  through 
the  hiatus  Fallopii,  to  join  the  large  superficial  petrosal  nerve 
at  the  Vidian  canal,  the  junction  of  the  two  forming  the 
Vidian  nerve. 

The  small  deep  petrosal  nerve  passes  backwards  in  a  small  canal 
in  the  processus  cochleariformis,  to  join  the  tympanic  plexus. 

The  cavernous  plexus  lies  below  and  to  the  inner  side  of 
last  bend  of  the  internal  carotid  artery. 

Branches : — 

Connecting  :  to  the  3rd,  4th,  and  ophthalmic  division  of  5th 
nerve. 

Ganghonic :  the  sympathetic  root  of  the  ophthalmic  or  lenti- 
cular ganglion  passes  into  the  orbit.  It  is  generally  joined  to 
the  branch  of  the  3rd  nerve  supplying  the  inferior  oblique. 

Pituitary :  to  that  body. 

2.  The  MIDDLE  CERVICAL  GANGLION  generally  lies  on  the 
inferior  thyroid  artery,  opposite  the  6th  cervical  vertebra. 

Branches : — 

Connecting  :  to  the  5th  and  6th  cervical  nerves. 

Thyroid:  to  the  thyroid  body,  communicating  with  external 

12 


T7*  THE  POCKET  ANATOMY 

and  recurrent  laryngeal  nerves,  and  with  the  upper  cardiac 
nerve  from  the  superior  ganglion. 

Middle  or  great  cardiac  nerve  :  on  the  right  side  passes  in 
front  or  behind  subclavian  artery  to  the  front  of  the  trachea, 
and  joins  the  deep  cardiac  plexus.  Communicates  in  the  neck 
with  the  upper  cardiac  and  recurrent  laryngeal  nerves.  On 
the  left  side  it  lies  between  the  left  carotid  and  left  subclavian 
arteries,  and  joins  the  deep  cardiac  plexus. 

3.  The   LOWER   CERVICAL    GANGLION    lies    between    the 
transverse  process  of  the  yth  cervical  and  the  neck  of  the 
ist  rib,  behind  the  vertebral  artery,  internal  to  the  superior 
intercostal  artery. 
Branches : — 

Connecting :  to  the  7th  and  8th  cervical  nerves. 
Lower  cardiac  nerve  :  passes  behind  the  subclavian  artery, 
joins  recurrent  laryngeal,  and  enters  the  deep  cardiac  plexus. 
Branches  to  vessels  :  branches  are  given  to  form  a  plexus 
round  the  vertebral  artery. 

The  THORACIC  PART  of  the  gangliated  cord  lies  by  the  side 
of  the  vertebrae  in  a  line  corresponding  to  the  heads  of  the 
ribs.  The  ganglia  are  usually  twelve  in  number,  and  each  com- 
municates with  the  corresponding  intercostal  nerve. 

Branches  of  the  upper  6  ganglia  are  given  off  to  the  thoracic 
aorta,  vertebras,  ligaments,  and  from  the  third  and  fourth  to 
the  posterior  pulmonary  plexus. 
Branches  from  the  lower  6  ganglia : — 

The  great  splanchnic  nerve :  formed  by  the  union  of 
branches  from  the  6th,  yth,  8th,  gth,  and  loth  ganglia.  It 
passes  inwards  over  the  bodies  of  the  vertebras,  perforates  the 
crus  of  the  diaphragm,  and  ends  in  the  semilunar  ganglion. 

The  small  splanchnic  nerve  comes  from  the  loth  and  nth 
ganglia,  passes  with  the  great  splanchnic  nerve,  and  ends  in 
the  solar  plexus. 

The  smallest  splanchnic  nerve  comes  from  the  i2th 
ganglion.  It  pierces  the  crus  of  the  diaphragm,  and  ends  in 
the  renal  plexus,  and  partly  in  the  coeliac  plexus. 

The  LUMBAR  PART  of  the  gangliated  cord  lies  nearer  the 
middle  line  than  the  thoracic  on  the  bodies  of  the  vertebrae. 
Each  ganglion  communicates  with  the  anterior  division  of 
a  lumbar  nerve  by  branches  which  pass  under  fibrous  arches 
of  psoas.  The  ganglia  give  off  branches  to  the  aorta,  and 
other  branches  to  form  the  hypogastric  plexus. 

The  SACRAL  PART  of  the  gangliated  cord  lies  to  the  inner 
side  of  the  anterior  sacral  foramina,  and  is  united  with  its 
opposite  fellow  at  the  lower  end  of  the  sacrum  by  a  cord,  in 


NERVES  179 

the  middle  of  which   there  is  sometimes  found  a  coccygeal 
ganglion  or  ganglion  impar. 

Branches  are  given  from  the  ganglia  to  the  pelvic  plexus, 
and  to  the  middle  sacral  plexus. 

THE  PREVERTEBRAL  PLEXUSES  OF  THE  SYMPATHETIC. 

The  CARDIAC  PLEXUS  lies  against  the  aorta  and  pulmonary 
artery.  It  is  divided  into  two  parts,  superficial  and  deep. 

The  superficial  cardiac  plexus  lies  in  concavity  of  the  arch 
of  the  aorta  on  the  right  of  the  ductus  arteriosus.  It  is  com- 
posed of  the  left  upper  cardiac  nerve  of  the  sympathetic,  the 
lower  cervical  cardiac  of  the  left  vagus  nerve,  and  branches 
from  the  deep  plexus.  In  the  plexus  is  the  small  ganglion  oj 
Wrisberg.  The  plexus  gives  branches  to  the  anterior  pul- 
monary plexus  of  the  left  side,  and  ends  in  the  right  coronary 
plexus  which  accompanies  the  right  coronary  artery. 

The  deep  cardiac  plexus  lies  between  the  arch  of  the  aorta 
and  the  trachea.  It  consists  of  right  and  left  halves  united 
by  branches.  The  right  half  lies  above  the  right  branch  of 
the  pulmonary  artery;  the  left  half  lies  on  the  left  of  the 
trachea,  close  to  the  ductus  arteriosus. 

Afferent  branches : — 

a.  All  the  cardiac  branches  from  the  cervical   ganglia 

of  the  sympathetic,  except  the  left  upper  nerve. 

b.  All  the  cardiac  of  pneumogastrics  and  recurrent  laryn- 

geals,  except  the  lower  cervical  cardiac  of  the  left 
vagus. 

Efferent  branches  from  the  right  side  join  the  superficial  cardiac 
plexus  to  form  the  right  coronary  plexus,  and  others  are 
distributed  to  the  right  auricle. 

Efferent  branches  of  the  left  side  mostly  end  in  the  left  coronary 
plexus,  which  accompanies  the  left  coronary  artery,  and  in 
the  superficial  cardiac  plexus. 

The  SOLAR  PLEXUS  is  the  largest  prevertebral  plexus.  It 
lies  behind  the  pancreas  and  inferior  vena  cava,  in  front  of  the 
aorta  and  crura  of  the  diaphragm.  It  surrounds  the  origin 
of  the  coeliac  axis,  extending  laterally  to  the  supra-renal 
bodies.  It  receives  the  large  and  small  splanchnic  nerves 
and  part  of  the  right  pneumogastric.  It  contains  several 
ganglia,  and  branches  are  given  off  from  it  to  accompany  the 
bloodvessels  to  the  viscera,  and  to  form  secondary  plexuses 
on  these  arteries. 

The  semilunar  ganglia,  one  in  each  half  of  the  solar  plexus, 
lie  on  the  inner  side  of  the  supra-renal  bodies,  the  left  one 

12—2 


i8o  THE  POCKET  ANATOMY 

lying  behind  inferior  vena  cava.  The  great  splanchnic  nerve 
enters  its  upper  end. 

The  diaphragmatic  or  phrenic  plexus  accompanies  the 
arteries  to  the  diaphragm.  On  the  right  side  near  the  supra- 
enal  body  is  the  phrenic  ganglion,  connecting  together  the 
phrenic  nerves  of  the  spinal  and  sympathetic  systems. 

The  supra-renal  plexus  is  derived  from  the  solar  plexus 
and  the  outer  part  of  the  semilunar  ganglion.  It  is  joined  by 
branches  of  one  of  the  splanchnic  nerves. 

The  renal  plexus  is  derived  from  the  semilunar  ganglion, 
and  partly  from  the  solar  and  aortic  plexuses,  and  receives 
the  smallest  splanchnic  nerve.  It  lies  along  the  renal  artery, 
and  contains  numerous  small  ganglia. 

The  spermatic  plexus  comes  off  from  the  renal  and  aortic 
plexuses. 

The  cceliac  plexus  is  derived  from  the  solar  plexus.  It 
surrounds  the  coeliac  axis,  and  subdivides  into  : — 

The  coronary  plexus  accompanies  coronary  artery  along  the 
smaller  curvature  of  the  stomach,  communicating  with  the 
pneumogastric  nerves. 

The  hepatic  plexus  accompanies  hepatic  artery  into  the  sub- 
stance of  the  liver.  Communicates  with  the  left  vagus,  and 
the  right  supra-renal  plexus.  Gives  off  the  cystic,  pyloric, 
right  gastro-epiploic  and  pancreatico-duodenal  plexuses. 

The  splenic  plexus  accompanies  splenic  artery  to  the  spleen, 
and  is  joined  by  the  right  pneumogastric.  It  gives  off  the 
left  gastro-epiploic  and  pancreatic  plexuses. 

The  superior  mesenteric  plexus  accompanies  superior 
mesenteric  artery. 

The  aortic  plexus  lies  on  the  anterior  surface  of  the 
abdominal  aorta.  It  gives  off  the  inferior  mesenteric  and  part 
of  the  spermatic  plexuses.  It  ends  in  the  hypogastric  plexus. 

The  HYPOGASTRIC  PLEXUS  lies  between  the  two  common 
iliac  arteries ;  it  is  formed  by  the  terminations  of  the  aortic 
plexus,  together  with  branches  from  the  lumbar  ganglia.  It 
divides  below  into  two  parts,  which  form  the  pelvic  plexuses. 

The  PELVIC  PLEXUSES  :  two  in  number.  Each  is  com- 
posed of  a  division  of  the  hypogastric  plexus,  joined  with 
some  branches  from  the  3rd  and  4th  sacral  nerves  and 
ganglia. 

The  following  plexuses  are  derived  from  the  pelvic 
plexuses : — 

The  hsemorrhoidal  plexus  to  the  rectum  and  anal  canal. 

The  vesical  plexus  to  the  bladder,  with  secondary  plexuses 
in  the  male  to  the  vas  deferens  and  to  the  vesiculae  seminales. 


THE  ORGANS  OF  DIGESTION  181 

The  prostatic  plexus  to  the  prostate  gland,  giving  off  the 
cavernous  nerves  of  the  penis. 

(The  vaginal  plexus  to  the  vagina. 

The  uterine  plexus  accompanying  the  uterine  artery  to  the 
uterus.) 

THE  ORGANS  OF  DIGESTION. 

THE   TEETH. 

Temporary  teeth :  the  following  is  the  dental  formula  for 
the  temporary  teeth,  with  the  dates  in  months  of  their 
eruption  : — 

Mo.  Mo.   Ca.      In.     In.     In.     In.     Ca.    Mo.    Mo. 
( Upper  ..i         i         i         i         i         i         i         i         i         i   =   io"\ 

( Lower  . .   i         i         i         i         i         i         i         i         i         i   =   ioj 
24       12       18        9        7         7         9       18       12       24  months. 

Permanent  teeth :  subjoined  is  the  dental  formula  for  the 
permanent  teeth,  with  the  date  in  years  of  their  eruption  : — 

Wis.  Mo.  Mo.  Bi.  Bi.  Ca.  In.  In.  In.  In.  Ca.  Bi.  Bi.  Mo.  Mo.  Wis. 
I  Upper     ixxiiixxiiiiiiii  =  i61 

I  Lower     ixixiixxiixixii      i  =  16  ) 
18    xa     6   10     9   ii      8     7     7     8    n      9    10     6    12    18  years. 

THE   TONGUE. 

The  tongue  occupies  the  floor  of  the  mouth ;  its  base  is 
connected  with  the  hyoid  bone,  the  epiglottis,  the  pillars  of 
the  soft  palate,  and  with  the  pharynx ;  along  its  inferior 
surface  the  genio-glossus  runs  from  base  to  tip,  connecting 
it  to  the  lower  jaw  and  hyoid  bone. 

The  mucous  membrane  on  the  under  surface  is  smooth, 
forming  in  front  a  median  fold,  the  franum  lingua;  on  the 
sides  it  is  continuous  with  the  mucous  membrane  of  the 
mouth.  On  the  dorsum  there  is  a  rapht  along  the  middle  line, 
which  ends  posteriorly  in  the  foramen  ccecum.  Posteriorly  the 
epiglottis  is  connected  to  the  tongue  by  three  glosso-epiglottic 
folds,  the  middle  one  being  called  the  fr&num  epiglottidis . 
The  anterior  two-thirds  of  the  dorsum  of  the  tongue  is  covered 
with  papillae  ;  they  are  of  three  kinds  : 

The  circumvallate  papillae  (seven  to  ten)  form  a  row  on  each 
side  at  the  back  of  the  tongue,  meeting  in  the  middle  line 
thus,  A,  in  front  of  the  foramen  caecum. 

The  fungiform  papilla:  found  principally  at  the  apex  ^nd 
on  the  sides. 


i82  THE  POCKET  ANATOMY 

The  filiform  papilla  are  numerous,  and  are  arranged  in  rows 
parallel  to  the  circumvallate,  but  towards  the  tip  of  the  tongue 
their  direction  becomes  more  transverse. 

Glands :  near  the  circumvallate  papillae  are  found  numerous 
mucous  glands,  known  as  the  lingual  glands. 

THE  MUSCLES  OF  THE  TONGUE. — The  extrinsic  muscles  of 
the  tongue  are  the  hyo-glossus,  genio-hyo-glossus,  palato- 
glossus,  and  the  stylo-glossus.  These  have  been  described 
(vide  pp.  29  and  30). 

The  intrinsic  muscles  are  entirely  contained  within  the  sub- 
stance of  the  tongue,  and  are  as  follows  : — 

The  superior  lingualis:  one  on  each  side.  Longitudinal 
fibres  lying  under  the  mucous  membrane.  It  arises  from 
the  fraenum  epiglottidis,  and  from  the  fascia  along  the  middle 
line ;  the  fibres  pass  obliquely  outwards,  the  anterior  fibres 
being  longitudinal,  to  the  side  of  the  tongue. 

The  inferior  lingualis  (2)  is  a  bundle  of  muscular  fibres 
running  along  the  under  surface  of  the  tongue  from  base  to 
tip.  It  lies  between  the  genio-hyo-glossus  and  hyo-glossus 
muscles.  It  arises  from  the  fascia  at  the  base  of  the  tongue, 
is  joined  anteriorly  with  some  fibres  of  the  stylo-glossus,  and 
passes  to  the  apex. 

Transverse  fibres  form  a  horizontal  layer  of  muscular  fibres 
'between  the  superior  and  inferior  linguales.  The  fibres 
spring  from  the  septum  and  pass  outwards  to  the  sides  of 
the  tongue. 

Vertical  fibres  arise  from  dorsum,  and  mingle  with  trans- 
verse fibres. 

The  septum  of  the  tongue  is  a  vertical  fibrous  partition, 
extending,  in  the  muscular  portion,  from  the  hyoid  bone  to 
the  apex. 

Arteries  :  lingual,  tonsillar  of  facial. 

Nerves :  lingual  or  gustatory  to  anterior  two  -  thirds ; 
glosso-pharyngeal  to  side  and  posterior  third  ;  hypoglossal 
to  muscles. 

THE   PALATE. 

The  palate  forms  the  roof  of  the  mouth,  and  consists  of 
two  parts — the  front  being  the  hard  palate,  and  the  back  the 
soft  palate. 

The  hard  palate  consists  of  the  palatal  processes  of  the 
superior  maxillae  and  palate-bones,  together  with  the  mucous 
membrane  and  the  periosteum  covering  them .  The  descending 
palatine  artery  and  anterior  palatine  nerve  run  forwards 
under  cover  of  alveolus. 


THE  ORGANS  OF  DIGESTION  183 

The  soft  palate,  consisting  of  muscles,  aponeurosis,  vessels, 
nerves,  etc.,  enclosed  between  two  layers  of  mucous  mem- 
brane, is  attached  in  front  to  the  posterior  margin  of  the 
hard  palate,  the  sides  blending  with  the  pharynx ;  from  the 
middle  of  the  posterior  edge  the  uvula  projects,  and  from  the 
bases  of  this  arch,  on  each  side,  there  are  two  folds  of  mucous 
membrane  enclosing  muscular  fibres — the  pillars,  anterior  and 
posterior,  between  which  the  tonsil  lies.  The  narrowed 
passage  between  the  anterior  pillars,  leading  from  the  mouth 
to  the  pharynx,  is  called  the  isthmus  faucium. 

The  aponeurosis  of  the  soft  palate  is  attached  to  the  posterior 
edge  of  the  hard  palate,  is  joined  by  the  tendon  of  the  tensor 
palati,  and  becomes  lost  between  the  muscles. 

Structure  of  the  palate  from  before  backwards  : 

1.  Oral  mucous  membrane  and  mucous  glands. 

2.  Palato-glossus. 

3.  Aponeurosis. 

4.  Tensor  palati. 

5.  Anterior  fibres  of  palato-pharyngeus. 

6.  Levator  palati. 

7.  Azygos  uvulae  in  middle  line. 

8.  Posterior  fibres  of  the  palato-pharyngeus. 

9.  Mucous  glands  and  pharyngeal  mucous  membrane. 
The  tonsils  occupy  the  recesses  between  the  pillars  of  the 

fauces,  the  anterior  pillar  being  formed  by  the  palato-glossus 
and  the  posterior  by  the  palato-pharyngeus.  On  the  outer 
side  of  each  is  the  superior  constrictor,  and  internally  the 
buccal  mucous  membrane.  Their  arterial  supply  is  large, 
from  the  ascending  pharyngeal,  ascending  and  descending 
palatine,  tonsiilar,  and  dorsalis  linguae  arteries. 


THE    SALIVARY   GLANDS. 

The  PAROTID  GLAND  is  the  largest,  and  lies  between  the 
external  auditory  meatus  and  mastoid  process  behind,  and 
the  vertical  ramus  of  the  jaw  in  front.  Anteriorly,  it  overlaps 
the  hinder  part  of  the  masseter. 

Boundaries : — 


Ex- 
ternally. 

Above. 

Below. 

Anteriorly 
and  Below, 

Behind, 

Skin. 

Zygoma. 

Line  from  angle 

Stylo-maxil- 

External     audi- 

Platysma. 
Cervical 

of  jaw  to  mas- 
toid process. 

lary    liga- 
ment. 

tory  meatus. 
Mastoid  process. 

fascia. 

Posterior  belly  of 

Sterno-mastoid. 

digastric 

[84 


THE  POCKET  ANATOMY 


The  deep  surface  is  irregular,  and  lies  on  the  styloid  process 
and  its  attached  muscles,  the  internal  jugular  vein,  the  vagus, 
spinal  accessory  and  hypoglossal  nerves,  and  is  divided  into 
three  lobes : — 

The  glenoid  lobe  fills  up  glenoid  cavity  behind  Glaserian 
fissure. 

The  pterygoid  lobe  passes  forwards  internal  to  the  ramus  of 
the  jaw  between  the  external  and  internal  pterygoid  muscles. 

The  carotid  lobe  surrounds  the  styloid  process,  and  lies 
between  the  external  and  internal  carotid  artery. 

The  socia  parotidis  is  a  separate  lobe  projecting  from  the 
anterior  surface. 

Relations  of  the  Socia  Parotidis  : — 


Above.  Below. 

Zygoma.          Duct. 

Cervico-facial  divi- 
sion of  facial  nerve. 


Internally. 
Masseter. 
Transverse  facial 
artery. 


The  duct  (Stenson's)  is  2  inches  long  ;  comes  off  from  the 
anterior  border  and  crosses  the  masseter  to  pierce  the 
buccinator  and  buccal  mucous  membrane.  Its  opening  in 
the  mouth  is  opposite  the  2nd  upper  molar  tooth. 

Course  of  the  duct:  line  from  bottom  of  lobule  of  ear  to 
middle  of  upper  lip.  The  transverse  facial  artery  lies  above 
the  duct,  and  the  buccal  branches  of  the  yth  nerve  below. 

The  parotid  gland  is  traversed  by  the  following,  of  which 
the  arteries  lie  deep  and  the  nerves  most  superficial. 


Veins.  Nerves. 

Internal  maxillary.    Facial. 
Temporal.  Auriculo-temporal. 

Temporo-maxillary .  Facial  of  great  auri- 
cular. 


Arteries. 

External  carotid. 
Posterior  auricular. 
Internal  maxillary. 
Superficial  tem- 
poral. 
Transverse  facial. 

Nerve  supply  of  gland :  sympathetic  and  glosso-pharyngeal. 
The  latter  branch  may  be  traced  as  follows  :  The  tympanic 
(Jacobson)  branch  gives  off  small  superficial  petrosal,  which 
passes  through  otic  ganglion  and  joins  the  auriculo-temporal 
trunk,  thus  supplying  the  gland. 

THE  SUBMAXILLARY  GLAND  lies  under  cover  of  the  body  oi 
the  lower  jaw. 

Superficial  lobe:  separated  by  stylo  -  maxillary  ligament 
from  parotid,  grooved  above  and  behind  by  facial  artery. 


THE  ORGANS  OF  DIGESTION  185 

Lies  upon.  Superficial  Coverings.  Below. 

Mylo-hyoid.  Platysma.  Tendon  of 

Stylo-hyoid.  Deep  fascia.  digastric. 

Hyo-glossus.  Facial  vein. 

Deep  lobe  :  passes  with  duct  between  mylo-hyoid  and  hyo- 
glossus. 

The  duct  of  Wharton :  passes  with  deep  lobe  of  gland 
beneath  mylo-hyoid,  resting  on  the  hyo-glossns.  At  first  the 
lingual  nerve  lies  above  the  duct  and  the  hypoglossal  nerve 
below,  but  the  duct,  crossing  over  the  nerve,  passes  up- 
wards and  forwards  on  genio-hyo-glossus  to  open  on  the 
papilla  by  the  side  of  the  fraenum  linguae. 

Nerves  :  sympathetic,  and  chorda  tympani  through  sub- 
maxillary  ganglion. 

THE  SUBLINGUAL  GLAND  occupies  the  sublingual  fossa  of 
lower  jaw,  lying  under  mucous  membrane  of  floor  of  mouth, 
and  having  its  anterior  extremity  close  to  the  fraenum.  Below 
is  the  mylo-hyoid,  and  internally  is  the  genio-hyo-glossus. 

Ducts  of  Rivini  (18  to  20) :  open  separately  in  the  floor  of 
the  mouth.  One  larger  one  from  the  posterior  part  opens 
into  or  by  the  side  of  Wharton's  duct,  and  is  called  the  duct 
of  Bartholin. 

Nerves :  sympathetic,  and  from  chorda  tympani  through 
submaxillary  ganglion. 


THE    PHARYNX. 

The  Pharynx  is  an  oval  musculo-membranous  bag  lying 
behind  the  nose,  mouth,  and  larynx.  It  is  about  4^  inches 
long,  and  extends  from  the  base  of  the  skull  to  the  lower 
border  of  the  cricoid  cartilage  in  front,  and  to  the  lower 
border  of  the  5th  cervical  vertebra  behind.  It  is  widest 
opposite  the  hyoid  bone.  Behind,  it  is  separated  by  a  pre- 
vertebral  layer  of  the  deep  cervical  fascia  from  the  longus 
colli  and  rectus  capitis  anticus  muscles  of  each  side.  Below, 
it  is  continuous  with  the  resophagus. 

A  ttachments : — 

Above :  under  surface  of  body  of  sphenoid,  under  surface 
of  petrous  of  temporal. 

In  front:  internal  pterygoid  plate,  pterygo-maxillary  liga- 
me%».  lower  jaw,  base  of  tongue,  cornua  of  hyoid  bone,  and 
styj  \  hyoid  ligament ;  thyroid  and  cricoid  cartilages,  corre- 
sponding to  attachments  of  constrictor  muscles. 


1 86 


THE  POCKET  ANATOMY 


Behind. 
Longi  colli. 
Recti  capitis  antici. 
Upper     5      cervical 

vertebrae. 
Prevertebral  fascia. 


Below. 
(Esophagus 


Relations  :— 

Laterally. 
Styloid  process. 
Stylo-hyoid.  ^  ^ 

Stylo-pharyngeus.  jo 
Internal  pterygoid.  I  & 
Sterno-thyroid.  I  £ 
Sterno-hyoid.  J  ^ 
Internal  and  common > 

carotid. 

Ascending  pharyngeal. 
Ascending  palatine. 
Tonsillar. 

Internal  jugular  vein. 
Glosso-phary  ngeal . 
Pneumogastric. 
Sympathetic. 
Spinal  accessory. 
Hypoglossal. 
Superior  laryngeal. 
Thyroid  gland. 

Muscles :  inferior,  middle  and  superior  constrictors,  stylo- 
pharyngeus,  palato-pharyngeus,  salpingo-pharyngeus.  (Vide 
pp.  29  and  30.) 

A  runes  :  Ascending  pharyngeal ;  pterygo-palatine  ;  ascend- 
ing and  descending  palatine  ;  dorsalis  linguae  ;  tonsillar. 

Openings  :  the  posterior  nares  (2),  placed  in  the  upper  part  of 
the  anterior  wall ;  Eustachian  tubes  (2),  open  one  on  each  side 
at  the  upper  part;  the  mouth,  situated  just  below  the  posterior 
nares  ;  the  laryngeal  and  cesophageal  openings. 

The  pharyngeal  wall  consists  of  4  layers  :  (i)  internally  a 
striated  squamous  epithelium  with  submucous  tissue ;  (2) 
pharyngeal  aponeurosis  ;  (3)  muscular  ;  (4)  an  indistinct  layer 
of  fascia  called  the  bucco-pharyngeal  fascia,  derived  from  the 
deep  cervical  fascia. 

The  pharyngeal  aponeurosis  forms  the  base  of  the  walls  of 
the  pharynx,  lying  between  the  mucous  membrane,  and  the 
muscles.  It  is  thin  below,  but  strong  above,  where  it  fills 
in  the  space  above  the  upper  crescentic  margin  of  the  superior 
constrictor  (sinus  of  Morgagni),  over  which  the  Eustachian 
tube  passes.  It  is  attached  above  to  the  body  of  the  sphenoid 
and  petrous  portion  of  the  temporal,  being  strengthened  in  the 
middle  line  by  a  process  of  fascia  attached  to  the  pharyngeal 
tubercle  on  the  basilar  part  of  the  occipital  bone.  Inferiorly 
it  becomes  lost  between  the  muscular  and  mucous  strata. 


THE  ORGANS  OF  DIGESTION 


187 


THE    (ESOPHAGUS. 

The  oesophagus  extends  from  pharynx  to  stomach,  and  is 
9  inches  long.  It  begins  at  the  lower  border  of  cricoid 
cartilage  opposite  the  5th  cervical  vertebra,  and  ends  opposite 
the  loth  dorsal. 

Course  and  relations  : — 

In  the  neck  :  passes  downwards  and  to  the  left. 


In  Front. 
Trachea. 
Thyroid  gland. 
Left       recurrent 

1  a  r  y  n  g  e  a  1 

nerve. 


Behind. 
Vertebrae. 
Left      longus 
colli  muscle. 


Left  Sidt. 
Left  inferior  thy- 
roid. 

Left  carotid. 
Left  subclavian. 
Thoracic  duct. 


Right  Side. 
Right  carotid. 
Right  recurrent 

1  a  r  y  n  g  e  a  1 

nerve. 


In  the  chest. — In  the  superior  mediastinum  passes  down- 
wards to  the  right  to  reach  middle  line  opposite  5th  dorsal 
vertebra. 

In  the  posterior  mediastinum  :  passes  forwards  and  down- 
wards to  the  left,  with  the  two  pneumogastrics,  which  form 
a  plexus  on  its  surface  ;  the  left  nerve  is  anterior,  and  the 
right  is  posterior. 

Behind. 


In  Front. 
Left  carotid  artery.        Longus  colli. 
bifurcation     of    Vertebra. 

trachea.  Thoracic  duct. 

Right     pulmonary    Venae     azygo 

artery. 

Left  bronchus. 
Left  recurrent  laryn-        vessels. 

geal  nerve.  Aorta  (below). 

Pericardium  and  left 

auricle. 
1  liaphragm. 


inores. 

Right  intercostal     Thoracic  aorta. 
Left  pleura. 


Left  Side.  Right  Side. 

Left     subclavian  Right  pleura. 

artery.  Vena      azygos 

Left  pneumogas-  major. 

trie  nerve. 
Arch  of  aorta. 


In  the  abdomen :  passes  through  cesophageal  opening  in 
diaphragm  opposite  the  disc  between  the  gth  and  roth  dorsal 
vertebrse,  to  end  at  the  cardiac  opening  of  the  stomach 
opposite  the  loth  dorsal  vertebra. 


THE   STOMACH. 

Form  :  conical,  with  base  or  fundus  to  left  side  ;  the  upper 
border  is  concave,  and  is  called  the  lesser  curvature ;  the 
lower  border  is  convex,  and  is  named  the  greater  curvature. 
The  left  extremity  is  known  as  the  fundus,  above  and  to  the 
right  of  which  is  the  cardiac  orifice,  and  the  right  or  small 
end  is  termed  the  pyloric  extremity. 


i88  THE  POCKET  ANATOMY 

Position  :  occupies  left  hypochondriac  and  epigastric 
regions. 

Orifices  :  cardiac,  above,  communicating  with  the  oeso- 
phagus; pyloric,  at  the  right  extremity,  passing  into  the 
duodenum. 

Dimensions :  10  to  12  inches  long ;  4  to  5  inches  in  diameter 
at  widest  part. 

Relations : — 

Left  or  cardiac  end  :  fixed  by  oesophagus  and  gastro-phrenic 
ligament  to  diaphragm,  lying  beneath  the  yth  left  costal 
cartilage,  i  inch  from  sternum  :  it  is  connected  with  the 
spleen  by  the  gastro-splenic  omentum. 

Right  or  pyloric  end .-  reaches  gall-bladder,  touching  under 
part  of  quadrate  lobe  of  liver ;  is  very  movable,  when  stomach 
is  empty  is  in  mid-line  on  line  midway  between  upper  border  of 
sternum  and  upper  border  of  pubis,  over  ist  lumbar  vertebra. 

Anterior  surface,  which  also  looks  upwards,  is  in  contact 
with,  from  left  to  right,  diaphragm,  abdominal  parietes  (epi- 
gastric region),  under  surface  of  liver. 

Posterior  surface  is  separated  from  diaphragm,  aorta,  pan- 
creas, spleen,  left  kidney,  and  supra-renal,  transverse  meso- 
colon  and  colon,  by  lesser  sac  of  peritoneum. 

Superior  border :  attached  to  liver  by  small  omentum. 

Inferior  border  :  gives  attachment  to  great  omentum. 

ARTERIES. — Coronary  and  pyloric  run  along  lesser  curvature ; 
right  and  left  gastro-epiploic,  along  inferior  or  greater  curvature ; 
vasa  brevia,  from  the  splenic  to  fundus. 

NERVES. — Right  pneumogastric,  to  posterior  surface;  left 
[neumogastric,  to  anterior  surface  ;  sympathetic,  from  the  solar 
plexus  to  both  surfaces. 

THE  SMALL  INTESTINES. 

THE   DUODENUM. 

Length  :  8  to  10  inches. 

Shape :  horse-shoe,  with  the  convexity  to  the  right  side,  the 
concavity  enclosing  the  head  of  the  pancreas. 

Position  :  occupies  epigastric  and  umbilical  regions. 

Has  no  mesentery,  and  is  only  partially  invested  by  peri- 
toneum. 

Divided  into  three  parts. 

Relations : — 

1st  part :  2  inches  long ;  directed  from  pylorus  upwards, 
backwards,  and  to  the  right,  reaching  the  neck  of  the  gall- 


THE  SMALL  INTESTINES  189 

bladder.  The  ist  inch  is  invested  with  peritoneum,  but  the 
2nd  inch  is  covered  in  front  only. 

In  front.  Liver,  gallbladder. 

Behind.  Bile  -  duct, 'vena  portae,  hepatic  artery,  gastro- 
duodenal  artery. 

Below.  Head  of  pancreas. 

2nd  part :  3^  inches  long ;  is  vertical ;  passes  from  opposite 
neck  of  gall-bladder  down  to  3rd  lumbar  vertebra.  Ducts  of 
liver  and  pancreas  enter  this  part.  Covered  in  front  by 
peritoneum. 

In  front.  Transverse  colon,  liver  and  gall-bladder,  small 
intestines. 

Behind.  Right  kidney,  supra-renal  capsule,  renal  vessels, 
and  inferior  vena  cava. 

Left  side.  Head  of  pancreas,  common  bile  -  duct,  and 
pancreatic  duct. 

Right  side.  Hepatic  flexure  of  colon. 

On  the  inner  aspect,  3^  or  4  inches  from  the  pylorus,  is 
the  bile  papilla,  on  which  is  the  orifice  for  both  the  common 
bile  and  pancreatic  ducts. 

3rd  part :  about  4^  inches  long  ;  passes  from  right  to  left 
across  spine,  ascending  from  3rd  to  and  lumbar  vertebra, 
ends  in  jejunum  on  left  side  of  spinal  column ;  lies  below 
transverse  meso-colon,  and  is  covered  in  front  by  peritoneum, 
except  where  root  of  mesentery  crosses  it. 

In  front.  Superior  mesenteric  vessels  and  plexus. 

Behind.  Aorta,  inferior  vena  cava,  crura  of  diaphragm,  left 
psoas,  and  left  renal  vessels. 

Above.  Pancreas. 

ARTERIES. — Pyloric,  and  superior  pancreatico-duodenal  of 
hepatic,  inferior  pancreatico-duodenal  of  superior  mesenteric. 

NERVES,  from  solar  plexus. 

THE   JEJUNUM    AND   ILEUM. 

The  jejunum  forms  f  of  the  rest  of  the  small  intestines, 
which  are  23  feet  long ;  commencing  on  the  left  side  of  the 
2nd  lumbar  vertebra,  it  terminates  in  the  ileum  ;  it  is  wider, 
and  its  coats  are  thicker,  more  vascular,  and  of  a  deeper 
colour  than  the  ileum. 

The  ileum  consists  of  the  remaining  f  of  the  small  intestines, 
and  terminates  in  the  right  iliac  fossa  by  opening  into  the  caecum. 

The  ileum  with  the  jejunum  is  suspended  from  the  posterior 
abdominal  wall  by  the  mesentery  (p.  196).  The  vessels  are 
derived  from  the  superior  mesenteric  artery,  and  the  veins 
drain  into  the  vein  of  the  same  name. 


i go  THE  POCKET  ANATOMY 

The  following  characteristics  will  serve  to  distinguish  the 
three  parts  of  the  small  intestines  : 


Duodenum. 
The  largest  part. 
Thickest  coats. 
Brunner's  glands. 
Valvular  conniventes. 
No  mesentery. 

Jejunum. 
More   vascular    than 
ileum. 
Valvulae  conniventes. 
Villi,  well  marked. 

Ileum. 

Villi,  small. 
Valvulae     conniventes, 
not    present  or  only 
slightly. 
Peyer's  patches. 

THE  LARGE  INTESTINE. 

Extent .-  from  the  ileum  to  the  anus.     Length  :  5  or  6  feet. 

Characteristics  of  Ccecum  and,  Colon. — Larger  size,  more  fixed 
than  the  small  intestine  ;  has  appendices  epiplo'icse.  The 
longitudinal  muscular  fibres  are  arranged  in  three  bands, 
which,  being  shorter  than  the  other  coats,  cause  sacculation. 

The  caecum  is  a  dilated  pouch  in  which  the  large  intestine 
commences,  situated  in  the  right  iliac  fossa,  and  completely 
covered  by  peritoneum  ;  at  the  lower,  inner,  and  back  part, 
and  generally  attached  by  a  mesentery  to  the  caecum,  is  the 
appendix  vermiformis,  a  blind  tubular  projection,  about  3  inches 
long,  and  about  the  size  of  a  large  quill. 

The  ileo-ccscal  valve  lies  on  the  left  side  of  the  caecum ;  is 
formed  by  the  two  inner  coats  of  the  ileum  passing  through 
the  wall  of  the  caecum.  The  upper  fold  is  horizontal,  and 
called  the  ileo-colic.  The  lower  is  vertical,  and  termed  the 
ileo-caecal.  The  ridge  on  either  side  is  called  the  frcznum. 

The  COLON  is  divided  into  ascending,  transverse,  descend- 
ing, iliac  and  pelvic. 

The  ascending  colon  extends  from  the  caecum  to  the  under 
surface  of  the  liver  to  the  right  of  the  gall-bladder,  where  it 
turns  to  the  left,  forming  the  hepatic  flexure.  It  lies  in  the  right 
lumbar  and  right  hypochondriac  regions.  The  peritoneum 
covers  the  anterior  and  lateral  surfaces.  Length,  8  inches. 

Relations. — In  front.  The  convolutions  of  the  ileum. 

Behind.  Iliacus,  quadratus  lumborum,  outer  side  of  right 
kidney. 

The  transverse  colon  passes  in  the  umbilical  region  from 
right  to  left,  from  the  gall-bladder  to  the  spleen.  It  forms 
an  arch,  convex  anteriorly  and  below  :  the  transverse  arch  of 
the  colon.  It  is  entirely  surrounded  by  peritoneum,  which  is 
attached  posteriorly  to  the  spine,  forming  the  meso-colon. 
Length,  20  inches. 

Relations. — Above.  Liver,  gall-bladder,  large  curvature  of 
stomach,  lower  end  of  spleen. 

Below.  Small  intestines. 

Anteriorly.  Anterior  layers  of  great  omentum,  anterior 
abdominal  wall. 


THE  LARGE  INTESTINE  191 

Posteriorly.  Right  kidney,  2nd  part  of  duodenum,  transverse 
meso-colon,  pancreas,  and  small  intestines. 

The  descending  colon  passes  from  the  end  ot  the  transverse 
colon  by  a  bend,  the  splenic  flexure.  Between  the  splenic 
flexure  and  the  diaphragm,  opposite  the  roth  left  rib,  is  a  fold 
of  the  peritoneum,  the  costo-colic  ligament,  which  slings  up  the 
spleen.  The  gut  then  passes  downwards  to  the  left  iliac  crest, 
ending  in  the  iliac  colon.  The  peritoneum  invests  its  anterior 
and  lateral  surfaces.  Length,  4  to  6  inches. 

Relations.— Behind.  Left  kidney,  quadratus  lumborum,  and 
psoas. 

In  front.  Small  intestine. 

Inner  side.  Outer  border  of  left  kidney. 

The  iliac  colon  is  continuous  with  the  descending  colon  at 
the  left  iliac  crest,  and  ends  at  the  inner  border  of  the  left  psoas. 

Peritoneum  invests  its  anterior  and  lateral  surfaces  ;  it  has 
no  mesentery. 

Relations. — In  front.  Small  intestines;  when  distended,  the 
anterior  abdominal  wall.  Behind.  Left  ilio-psoas. 

Length.  5  to  6  inches. 

The  pelvic  colon  extends  from  the  inner  border  of  the 
psoas  to  the  level  of  the  3rd  sacral  vertebra. 

Length.  16  or  17  inches  ;  very  variable.  It  has  an  extensive 
mesentery. 

Relations.—  Passing  over  left  brim  of  pelvis,  it  crosses  left 
external  iliac  vessels  and  left  ureter,  and  passes  to  right 
margin  of  pelvis,  resting  on  bladder  in  male  and  uterus  in 
female  ;  above  lie  coils  of  small  intestine.  It  then  turns  back 
to  mid-line  on  posterior  wall  of  pelvis,  and,  forming  a  second 
bend,  descends  to  end  in  the  rectum. 

The  rectum :  — 

Extent. — From  the  3rd  sacral  vertebra  to  the  tip  of  the 
coccyx  (5  to  6  inches  long). 

Relations. — It  has  peritoneum  on  the  upper  §  of  anterior 
surface  only,  and  no  mesentery. 

In  front.  Recto-vesical  pouch :  triangular  area  at  base  of 
bladder,  vesiculaeseminales,  vasa  deferentia,  posterior  surface 
•of  prostate  (male),  posterior  wall  of  vagina  (female). 

Behind.  Sacrum,  coccyx,  levatores  ani. 

Laterally.  Pararectal  fossa,  below  coccygeus. 

The  anal  canal  :— 

Extent. — From  the  tip  of  the  coccyx  to  anus  (i  to  i£  inches 
Jong). 

Direction.  Downwards  and  backwards. 

Relations : — 

In  front.  Membranous  part  of  the  urethra,  bulb  of  corpus 


192  THE  POCKET  ANATOMY 

spongiosum  (male),  posterior  wall  of  vagina,  the  perineum 
intervening  (female). 

Laterally  and  behind.  Levatores  ani,  which,  uniting,  support 
it  as  in  a  sling.  Internal  and  external  sphincters.  Ischio- 
rectal  fossa. 

THE  LIVER. 

Situation.— Right  and  left  hypochondriac  and  epigastric 
regions. 

Average  weight. — 50  ounces. 

Upper  surface.  Convex,  covered  by  peritoneum;  above  is 
the  diaphragm.  It  is  divided  into  two  unequal  lobes  (right 
and  left)  by  a  fold  of  peritoneum,  called  the  suspensory  or 
broad  ligament.  In  relation  with  the  diaphragm, 

Under  surface.  Concave,  and  is  in  relation  with  the  stomach, 
pylorus,  duodenum,  hepatic  flexure,  right  kidney,  and  right 
supra-renal  body  ;  is  covered  with  peritoneum,  except  where 
gall-bladder  is  attached,  and  at  the  transverse  fissure,  and 
at  the  fissure  for  ductus  venosus,  which  give  attachment  to 
the  lesser  omentum. 

Posterior  surface.  Is  broad  and  round :  connected  to  dia- 
phragm over  right  lobe  by  the  coronary  ligament, (between 
the  two  layers  of  which  its  surface  is  non-peritoneal.  On 
this  surface,  opposite  the  loth  and  nth  dorsal  vertebrae,  is 
the  Spigelian  lobe,  which  bounds  the  lesser  sac  in  front. 
Right  supra-renal  capsule,  inferior  vena  cava,  aorta,  oeso- 
phagus, and  lesser  peritoneal  sac  lie  behind. 

Anterior  surface.  Triangular,  and  marked  by  a  notch  opposite 
the  attachment  of  the  suspensory  ligament.  In  relation  with 
diaphragm  and  anterior  abdominal  wall. 

Right  surface.  Convex  and  in  relation  with  diaphragm. 

The  LIGAMENTS  are  five  in  number ;  four  are  composed  of 
peritoneum,  and  are  : — 

The  suspensory,  falciform,  or  broad  ligament,  sickle-shaped, 
with  the  base  forward.  It  is  attached  above  to  the  diaphragm, 
extending  on  to  the  sheath  of  rectus  as  far  as  the  umbilicus, 
and  below  from  the  notch  in  front,  to  the  posterior  edge  of 
the  liver.  The  inferior  edge  encloses  the  round  ligament. 

The  lateral  ligaments,  right  and  left,  extend  from  the  sides 
of  the  diaphragm  to  the  posterior  border  of  the  liver. 

The  coronary  ligament  is  continuous  with  the  lateral  liga- 
ments, and  attaches  the  posterior  surface  of  right  lobe  of 
the  liver  to  the  diaphragm. 

The  round  ligament  is  the  obliterated  umbilical  vein  and 
ductus  venosus  contained  within  the  posterior  or  free  edge  of 
the  suspensory  ligament. 


THE  LIVER  193 

FISSURES  : — 

The  longitudinal  fissure  is  occupied  by  the  round  ligament, 
and  divides  the  organ  into  right  and  left  lobes ;  it  is  separated 
into  two  parts  by  its  union  with  the  transverse  fissure. 

The  anterior  part  or  umbilical  fissure  contains  the  remains 
of  the  umbilical  vein,  and  lies  between  the  left  lobe  and  the 
lobus  quadratus.  The  posterior  part  or  fissure  of  the  ductus 
venosus  lies  between  the  left  lobe  and  the  lobus  Spigelii,  and 
contains  the  remains  of  the  ductus  venosus. 

The  transverse  or  portal  fissure  is  placed  at  right  angles  to 
the  longitudinal  fissure,  between  the  lobus  quadratus  and  the 
lobus  Spigelii,  and  lodges  the  hepatic  ducts,  artery,  and  portal 
vein,  nerves  and  lymphatics.  The  artery  lies  between  the 
duct  in  front,  and  the  vein  behind. 

The  fissure  for  the  inferior  vena  cava  is  placed  obliquely  at 
the  posterior  margin  of  the  liver,  behind  the  gall-bladder, 
lying  between  the  right  lobe  and  the  lobus  Spigelii,  and  sepa- 
rated from  the  transverse  fissure  by  the  lobus  caudatus.  The 
hepatic  veins  enter  the  vena  cava  at  the  bottom  of  this  fissure. 

LOBES : — 

Right  and  left  lobes  are  separated  from  each  other  by  the 
umbilical  fissure  on  the  under  surface,  and  posteriorly  by  th^ 
fissure  of  the  ductus  venosus.  The  right  is  the  larger,  ami 
contains  the  transverse  fissure  and  fissure  for  the  inferior 
vena  cava  ;  is  subdivided  into  the  three  following  lobes : — 

Tiie  lobus  quadratus  :  bounded  by  the  umbilical  and  trans- 
verse fissures  and  the  fossa  of  the  gall-bladder. 

The  lobus  Spigelii  is  on  the  posterior  surface,  and  is  the 
projection  between  fissures  for  the  inferior  vena  cava  and 
ductus  venosus,  behind  the  transverse  fissure. 

The  lobus  caudatus  connects  the  preceding  lobe  with  the 
main  mass  of  the  right  lobe,  and  lies  behind  the  transverse 
fissure. 

FOSSA  : — 

The  fossa  for  the  gall-bladder  lies  on  the  under  surface  of 
the  right  lobe,  parallel  to  the  umbilical  fissure,  and  separates 
the  quadrate  lobe  from  the  main  mass  of  the  right  lobe. 

THE   GALL-BLADDER    AND   BILE-DUCTS. 

The  gall-bladder  is  a  conical  bag  placed  in  a  fossa  on  the 
under  surface  of  the  right  lobe  of  the  liver.  Its  upper  surface 
is  attached  to  the  liver,  and  its  fundus  and  posterior  surfaces 
are  invested  by  peritoneum  reflected  from  the  adjacent  surface 
of  the  liver. 

Relations. — The  body  is  in  relation  in  front  with  the  liver 

13 


194  THE  POCKET  ANATOMY 

and  behind  with  the  ist  part  of  duodenum,  and  the  hepatic 
flexure  of  colon.  The  fundus  is  in  contact  with  the  parietes 
opposite  the  gth  right  costal  cartilage. 

The  cystic  duct  passes  from  the  neck  of  the  gall-bladder 
downwards,  backwards,  and  to  the  left,  to  join  the  hepatic 
duct  at  the  mouth  of  the  portal  fissure. 

The  hepatic  duct,  formed  by  union  of  ducts  from  right  and 
left  lobes,  issues  from  the  liver  at  the  bottom  of  the  transverse 
fissure.  It  joins  the  cystic  duct,  the  two  forming  the  common 
bile-duct.  Its  length  is  i  inch,  and  it  lies  entirely  within  the 
portal  fissure. 

The  ductus  communis  ckoledoclms  or  common  bile-duct 
results  from  the  union  of  the  hepatic  and  cystic  ducts.  It 
passes  downwards  in  front  of  the  foramen  of  Winslow  in  the 
layers  of  the  gastro-hepatic  omentum,  having  the  vena  porta 
behind,  and  the  hepatic  artery  on  the  left.  It  then  descends 
behind  the  ist  part  of  the  duodenum,  and,  passing  between 
the  pancreas  and  2nd  part  of  the  duodenum  where  it  lies  on 
the  inferior  vena  cava,  it  enters  the  small  intestine  obliquely, 
a  little  below  the  middle  of  the  descending  part  of  the  duo- 
denum, by  an  opening  on  the  biliary  papilla  (p.  189)  common 
to  it  and  the  pancreatic  duct.  Length  3  inches. 
Vessels  of  the  liver : — 

The  hepatic  artery  from  the  coeliac  axis  enters  the  trans- 
verse fissure  and  divides  into  two  branches  for  the  right  and 
left  lobes.  The  right  branch  gives  off  the  cystic  branch  to 
the  gall-bladder. 

The  portal  vein,  having  the  hepatic  artery  on  the  left  and  in 
front,  and  the  common  bile-duct  on  the  right,  ascends  between 
the  layers  of  the  gastro-hepatic  omentum,  in  front  of  the  fora- 
men of  Winslow,  to  the  transverse  fissure.  The  vessels,  accom- 
panied by  nerves  and  lymphatics,  are  surrounded  by  areolar 
tissue,  the  capsule  of  Glisson,  which  passes  with  them  into  the 
liver. 

The  hepatic  veins  pass  out  of  the  liver  at  the  bottom  of  the 
fissure  of  the  inferior  vena  cava,  immediately  joining  that 
vessel. 

THE  PANCREAS. 

Length  :  6  to  8  inches.  Consists  of  a  body,  enlarged  to  the 
right  at  its  head,  with  which  the  body  is  connected  by  a  narrow 
part  or  neck,  and  narrowed  to  the  left,  where  it  ends  as  the  tail. 

Position. — Placed  in  the  epigastric  and  left  hypochondriac 
regions,  directed  transversely  across  posterior  wall  of  abdomen. 


THE  PANCREAS  195 

Relations  of  the  body  : — 

Upper  surface.  Stomach  and  small  omentum :  covered  by 
peritoneum. 

Posterior  surface.  Aorta,  crura  of  diaphragm,  splenic  vein, 
left  kidney,  left  supra-renal  body  and  left  renal  vessels. 

Upper  border.  From  right  to  left ;  creliac  axis,  splenic 
artery. 

Inferior  surface.  From  right  to  left ;  duodeno-jejunal 
flexure,  splenic  flexure,  and  small  intestines :  covered  by 
peritoneum. 

Left  end  or  tail.  Touches  lower  part  of  internal  surface  of 
spleen. 

Right  end  or  head.  Embraced  by  three  parts  of  duodenum, 
from  which  it  is  partly  separated,  behind  by  common  bile- 
duct,  and  in  front  by  pancreatico-duodenal  arteries.  Is 
covered  in  front  by  transverse  colon :  the  superior  mesen- 
teric  vessels  overlap  the  left  end  of  the  head,  lying  in  a 
groove  on  the  anterior  surface.  Behind  are  inferior  vena 
cava  and  right  renal  vessels. 

Neck  lies  on  the  1st  and  2nd  lumbar  vertebrae,  from  which 
it  is  separated  by  the  crura  of  the  diaphragm,  superior  mesen- 
teric  vessels,  and  portal  vein. 

Duct  (canal  of  Wirsung) :  extends  transversely  from  left  to 
right,  opens  into  2nd  part  of  the  duodenum  in  common  with 
the  ductus  communis  choledochus. 

Arteries:  pancreatic  of  splenic,  superior  pancreatico-duo- 
denal of  hepatic,  and  inferior  pancreatico-duodenal  of  superior 
mesenteric. 

Veins  :  open  into  splenic  and  superior  mesenteric. 

Nerves :  from  the  solar  plexus. 

THE  SPLEEN 

situated  in  the  left  hypochondrium  and  epigastrium,  is  of  an 
oblong,  flattened  form,  the  external  surface  being  convex  ; 
on  the  inner  surface  is  a  vertical  ridge  dividing  it  into  two 
parts,  the  posterior  of  which  is  applied  to  the  outer  surface 
of  the  left  kidney,  whilst  the  anterior  receives  the  tail  of 
the  pancreas,  and  lies  against  the  fundus  of  the  stomach. 
Near  this  ridge  is  a  fissure,  the  hilum,  where  the  vessels  enter. 
The  anterior  border  is  notched,  and  the  inferior  or  basal  sur- 
face is  triangular,  and  rests  on  the  costo-colic  ligament  (vide 
S.  191)  and  the  splenic  flexure.  It  is  covered,  except  at  the 
ilum,  by  peritoneum,  which  here  passes  forwards  and  inwards 
in  a  double  line  enclosing  the  vessels,  as  the  gastro-splenic 

13—2 


ig6  THE  POCKET  ANATOMY 

omentum,  to  the  fundus  of  the  stomach:  behind  the  hilum 
two  layers  pass  on  to  the  left  kidney  as  lieno-renal  ligament. 

Relations. — External  surface.  Diaphragm,  which  separates 
it  from  the  gth,  ioth,  and  nth  left  ribs  and  pleura. 

Internal  surface.  In  front  of  the  hilum.  Fundus  of  stomach . 
Behind  the  hilum.  Left  kidney,  left  supra-renal  body.  Below 
the  hilum.  Tail  of  pancreas. 

Inferior  surface.   Costo-colic  ligament  and  splenic  flexure. 

Arteries:  Splenic. 

Nerves  :  Branches  from  solar  plexus  of  the  sympathetic. 


THE  PERITONEUM. 

The  peritoneum  is  the  serous  membrane  of  the  abdominal 
cavity.  It  consists  of  a  parietal  layer  lining  the  abdominal  and 
pelvic  walls,  and  a  visceral  layer  reflected  more  or  less  over 
the  contained  organs.  In  the  male  it  is  a  closed  sac,  but  in 
the  female  the  free  extremities  of  the  Fallopian  tubes  open 
into  the  cavity.  The  continuity  of  the  peritoneum  may  bt, 
traced  in  the  following  manner. 

Commencing  at  the  middle  line  and  passing  horizontally, 
the  peritoneum  lines  the  right  half  of  the  abdominal  wall, 
as  far  as  the  lumbar  region,  where  it  entirely  surrounds  the 
caecum  and  vermiform  appendix.  It  only  invests  the  front 
and  sides  of  the  ascending  colon,  though  occasionally  the 
whole  circumference  of  the  gut  is  enclosed,  a  meso-colon 
being  then  formed.  The  peritoneum  then  passes  inwards, 
covering  the  lower  part  of  the  anterior  surface  of  the  right 
kidney,  the  front  of  the  3rd  part  of  duodenum,  and  goes 
downward  over  the  front  of  the  vessels  of  the  small  intestines, 
encloses  the  small  intestines,  and  is  reflected  upwards  on  the 
posterior  surface  of  the  vessels  to  the  spine,  thus  forming  the 
mesentery.  From  the  spine  it  may  be  traced  to  the  left  over 
the  lower  part  of  the  anterior  surface  of  the  left  kidney  to  the 
descending  and  iliac  colon,  and  thence  on  to  the  abdominal 
parietes  to  the  middle  line.  The  descending  and  iliac  colon 
is  invested  in  a  similar  manner  to  the  ascending. 

The  peritoneum  of  the  pelvis  is  continuous  with  that  of  the 
abdominal  cavity.  It  encloses  completely  the  pelvic  colon, 
and  forms  the  pelvic  meso-colon.  It  is  applied  to  the 
front  and  sides,  and  lower  down  to  the  front  only  of  the 
rectum,  whence  it  is  reflected  in  the  male  on  to  the  base 
and  upper  part  of  the  bladder,  forming  the  recto-vesical 
pouch ;  this  is  bounded  on  each  side  by  the  peritoneum 


THE  PERITONEUM  197 

reflected  forwards  from  the  sides  of  the  rectum  over  the 
obliterated  hypogastric  artery  and  ureter,lformingthe/>osten'or 
false  ligament  of  the  bladder. 

From  the  apex  of  the  bladder  the  peritoneum  passes  upwards 
on  to  the  anterior  abdominal  wall,  enclosing  the  remains  of 
the  urachus  and  constituting  the  anterior  false  ligament  of  the 
bladder  ;  whilst  laterally  it  is  reflected  from  the  bladder  along 
the  line  of  the  obliterated  hypogastric  artery  to  the  iliac  fossa, 
forming  the  lateral  false  ligaments  of  that  viscus.  Where  the 
obliterated  hypogastric  artery  passes  between  the  abdominal 
wall  and  the  side  of  the  bladder  it  raises  the  peritoneum  into 
a  fold,  which  separates  two  shallow  fossae,  the  internal  and 
external  inguinal  fosses,  which  correspond  respectively  to  the 
internal  and  external  abdominal  rings. 

In  the  female  the  peritoneum  is  reflected  from  the  sides 
and  front  of  the  rectum  to  the  upper  part  of  the  posterior 
wall  of  the  vagina,  and  thence  over  posterior,  upper,  and 
anterior  surfaces  of  the  uterus  to  the  bladder.  Between  the 
uterus  and  rectum  is  the  recto-vaginal  or  Douglas's  pouch, 
corresponding  to  the  recto-vesical  pouch  in  the  male.  The 
peritoneum  passes  off  from  the  lateral  margins  of  the  uterus 
to  the  pelvic  wall,  forming  the  broad  ligaments,  in  the  upper 
border  of  which  folds  the  Fallopian  tubes  run,  the  peri- 
toneum being  continuous  with  their  open  fimbriated  ex- 
tremities. 

In  the  upper  part  of  the  abdomen  the  peritoneum  is 
attached  to  the  under  surface  of  the  diaphragm  as  far  back- 
wards as  the  posterior  surface  of  the  liver,  and  the  oesophageal 
opening  of  the  stomach.  It  is  then  reflected  forwards  on  the 
upper  surface  of  the  liver,  forming  the  ligaments  of  that 
organ  ;  and  passing  round  the  anterior  border  it  is  applied  to 
the  under  surface  as  far  as  the  transverse  fissure,  where, 
meeting  a  peritoneal  layer  from  the  posterior  surface  (from 
the  smaller  sac),  the  two  descend  to  the  stomach  to  form 
the  small  or  gastro-hepatic  omentum.  Tracing  it  to  the 
right  from  the  longitudinal  fissure,  it  invests  the  gall-bladder, 
under  surface  of  the  right  lobe,  and  the  front  of  the  2nd  part 
of  the  duodenum,  passing  to  the  anterior  surface  of  the  right 
kidney,  where  it  becomes  continuous  with  the  part  already 
traced.  To  the  left  of  the  longitudinal  fissure  the  peritoneum 
covers  the  left  lobe  of  the  liver,  and  is  reflected  over  the  front 
of  the  cardiac  end  and  fundus  of  the  stomach,  whence  it  passes 
off  to  invest  the  spleen,  forming  a  reduplicature,  the  gastro- 
splenic  omentum.  From  the  spleen  it  is  continued  over  the 
anterior  surface  of  the  left  kidney,  forming  the  posterior 


i98  THE  POCKET  ANATOMY 

layer  of  the  lieno-renal  ligament,  and  over  the  descending 
colon  to  join  the  part  already  described. 

Between  the  liver,  stomach,  and  transverse  colon  is  a 
diverticulum  of  the  main  peritoneal  sac,  which  communicates 
with  the  larger  peritoneal  cavity  through  the  foramen  of  Win- 
slow.  To  understand  the  disposition  of  the  layers  one  has 
only  to  imagine  the  smaller  sac  to  have  been  invaginated 
through  the  foramen  of  Winslow  inwards  and  behind  the 
stomach,  and  the  arrangement  becomes  clear. 

The  two  sacs  traced  vertically. 

From  transverse  fissure  of  liver,  two  layers  pass  : — 

To  small  curvature  of  stomach. 

Two  layers  separate,  one  passing  in  front  and  the  other 
behind  stomach,  thus  enclosing  it. 

Join  together  at  great  curvature,  forming  anterior  layers 
of  great  omentum. 

Pass  down  in  front  of  and  beyond  transverse  colon. 

Bend  upwards  and  backwards,  and  separate  to  enclose 
transverse  colon ;  continue  together  to  the  posterior  abdominal 
wall,  until  opposite  the  anterior  border  of  the  pancreas,  where 
they  part,  one  layer  passing  upwards,  and  the  other  down- 
wards. 

The  ascending  layer  passes  : — 

Over  upper  surface  of  pancreas  and  posterior  part  of 
diaphragm. 

Then  on  to  posterior  surface  of  liver  to  the  transverse  fissure. 

The  descending  layer  passes  :  — 

Along  superior  mesenteric  vessels,  round  jejunum  and  ileum, 
and  back  to  spine,  forming  mesentery. 

Downwards  in  front  of  spine,  lower  part  of  aorta  and  sacral 
promontory. 

Over  pelvic  colon,  forming  pelvic  meso-colon. 

Forwards. 
Male.  —  To  bladder,   forming  recto-vesical  pouch   and 

posterior  false  ligaments. 

Female. — To  vagina  and  uterus,  forming  posterior  liga- 
ments of  uterus  and  recto-vaginal  pouch.  Then  over 
uterus  to  bladder,  forming  utero-vesical  pouch  and 
posterior  vesical  ligaments. 

Over  bladder  to  anterior  abdominal  wall,  covering  urachus 
and  obliterated  hypogastric  arteries  as  far  as  umbilicus. 

Over  under  surface  of  diaphragm. 

Reflected  over  upper  surface  of  liver. 


THE  PERITONEUM  199 

Round  anterior  border  of  liver  to  under  surface  as  far  as 
transverse  fissure. 

The  two  sacs  traced  horizontally,  at  the  level  oj  the  foramen  of 
Winslow. 

From  falciform  ligament  of  liver : — 

Over  anterior  abdominal  wall  and  diaphragm. 

Over  outer  part  of  left  kidney. 

Reflected  outwards  behind  splenic  vessels  to  spleen,  forming 
posterior  layer  of  lieno-renal  ligament. 

Over  spleen  as  far  as  hilum. 

To  stomach,  forming  anterior  layer  of  gastro-splenic 
omentum. 

Over  anterior  wall  of  stomach  into  anterior  layer  of  gastro- 
hepatic  omentum. 

Turns  round  hepatic  artery,  forming  anterior  edge  of 
foramen  of  Winslow  (here  the  smaller  sac  commences). 

Passing  from  right  to  left : — 

Forms  posterior  layer  of  small  omentum. 

Over  posterior  surface  of  stomach. 

Forms  posterior  layer  of  gastro-splenic  omentum,  reaching 
hilum  of  spleen. 

Forms  anterior  layer  of  lieno-renal  ligament. 

Passing  now  from  left  to  right : — 

Continues  over  left  kidney,  aorta,  and  inferior  vena  cava, 
here  forming  posterior  boundary  of  foramen  of  Winslow  (here 
smaller  sac  ends,  and  large  sac  again  commences). 

Over  right  kidney  to  liver. 

Over  under-surface  of  liver  to  left  border,  round  which  it 
may  be  traced  over  anterior  surface,  to  falciform  ligament. 

SYNOPSIS   OF   PROCESSES   OF   THE    PERITONEUM. 

Omenta — folds  connected  with  the  stomach. 

Lesser  or  Gastro-hepatic  Omentum. — From  transverse  fissure 
and  fissure  for  ductus  venosus  on  liver  to  small  curvature  of 
stomach  and  ist  part  of  duodenum.  Right  border  free, 
forming  anterior  boundary  of  foramen  of  Winslow. 

Great  or  Gastro-colic  Omentum. — Formed,  as  shown  above, 
by  the  passing  downwards  and  then  folding  upwards  of  the 
two  layers  passing  from  stomach,  and  thus  encloses  the  lower 
part  of  the  cavity  of  the  smaller  sac  of  the  peritoneum. 

Gastro-splenic  Omentum. — Passes  from  fundus  of  stomach 
to  hilum  of  spleen,  and  contains  the  splenic  vessels  be- 
tween its  layers.  Below  it  is  continuous  with  the  great 
omentum. 


200  THE  POCKET  ANATOMY 

Mesenteries — folds  connecting  intestine  to  posterior  ab- 
dominal wall. 

The  Mesentery. — Attached  behind  to  left  side  of  2nd  lumbar 
vertebra,  passing  downwards  across  vertebras  to  right  sacro- 
iliac  synchondrosis.  Contains  superior  mesenteric  vessels, 
jejunum  and  ileum  between  its  layers.  The  upper  layer 
is  continuous  with  inferior  layer  of  transverse  meso-colon, 
the  lower  layer  with  peritoneum  on  posterior  abdominal 
wall. 

Transverse  Meso-colon.—  Formed  by  junction  of  two  ascend- 
ing layers  of  great  omentum  after  they  have  enclosed 
transverse  colon;  at  the  spine  the  two  layers  separate,  as 
explained,  into  ascending  and  descending  layers. 

Pelvic  Meso-colon.  —  A  long  process  attached  to  brim  of 
pelvis. 

Ligaments. — The  peritoneum,  as  explained,  is  reflected 
from  the  abdominal  walls  to  viscera,  forming  ligaments. 

Ligaments  of  the  Liver : — 

Suspensory  or  Falciform. — Sickle-shaped  fold  passing  from 
anterior  abdominal  wall  to  upper  and  anterior  surfaces  of 
liver.  The  inferior  free  border  contains  obliterated  umbilical 
vein  or  round  ligament. 

Coronary. — Connects  right  lobe  to  diaphragm  ;  consists  of 
two  layers,  the  anterior  being  derived  from  greater  sac,  and 
the  posterior  from  lesser  sac. 

Lateral  (2). — These  are  the  right  and  left  ends  of  the 
coronary  ligament. 

Ligaments  (False)  of  the  Bladder : — 

Posterior  False  Ligaments  (2). — The  edges  of  the  recto-vesical 
pouch. 

Lateral  False  Ligaments  (2).  —  Reflection  from  sides  of 
bladder. 

Superior  False  Ligament. — Reflection  from  bladder  to  anterior 
abdominal  wall  along  urachus. 

Ligaments  of  the  Uterus  : — 

Broad  Ligaments  (2).— Each  passes  from  side  of  uterus  to 
lateral  pelvic  wall  :  contains  between  its  folds  the  round 
ligament,  Fallopian  tube,  the  ovary,  and  its  ligament  and 
branches  of  ovarian  and  uterine  vessels. 

Anterior  Ligaments  (2). — Margins  of  utero-vesical  pouch. 

Posterior  Ligaments  (2). — Margins  of  recto-vaginal  pouch. 

Ligament  of  Spleen,  or  lieno-renal  ligament,  passes  from  left 
kidney  to  spleen  ;  the  right  or  anterior  layer  is  formed  by  the 
lesser  sac,  and  the  left  or  posterior  by  the  larger  one. 


Behind, 

Above. 

Below. 

Between 
the  layers 
of  the 

Inferior 
vena  cava. 
Right    crus 
of 

Caudate 
lobe. 

ist    part    of 
duodenum. 
Commence- 
ment     of 

small 
omentum. 

diaphragm. 

hepatic   ar- 
tery. 

THE  MEDIASTINA  201 

Costo-colic  ligament  (vide  p.  191.) 

The  foramen  of  Winslow  is  the  orifice  behind  the  right  free 
margin  of  the  small  omentum,  by  which  the  smaller  peritoneal 
sac  communicates  with  the  general  peritoneal  cavity. 

Relations : — 

In  Front. 

Hepatic  artery. 
Portal  vt-.in. 
Common  bile-duct. 


THE  MEDIASTINA. 

The  superior  mediastinum  is  the  space  above  the  peri- 
cardium extending  upwards  to  the  root  of  the  neck. 

Boundaries : — 

Above.  Superior  aperture  of  the  thorax. 

Below.  Plane  passing  from  lower  part  of  body  of  4th  dorsal 
vertebra,  to  the  junction  of  the  gladiolus  and  manubrium  of 
sternum. 

In  front.  Manubrium  and  origins  of  sterno-hyoid  and  sterno- 
thyroid  muscles. 

Behind.  First  four  dorsal  vertebrae,  and  lower  ends  of  longi 

coin. 

Laterally.  The  parietal  or  mediastinal  pleura,  passing  back 
from  posterior  surface  of  sternum  to  vertebrae. 

Contents.  Trachea  (lower  end),  oesophagus,  thoracic  duct, 
transverse  part  of  arch  of  aorta,  innominate  artery,  thoracic 
part  of  left  carotid  and  subclavian  arteries,  innominate  veins, 
upper  part  of  superior  vena  cava,  phrenic  and  pneumogastnc 
nerves,  left  recurrent  laryngeal  and  the  cardiac  nerves, 
lymphatic  glands  and  remains  of  thymus  gland. 

The  anterior  mediastinum  is  the  space  between  the  two 
pleurae  in  front  of  the  pericardium  ;  it  is  narrow  above,  but 
broader  below. 

Boundaries  : — 

In  front.  Sternum,  with  5th,  6th,  and  part  of  yth  left  costal 
cartilages,  triangularis  sterni,  and  left  internal  mammary 
vessels. 

Behind    Pericardium. 

T..iterallv    Pleura 


202  THE  POCKET  ANATOMY 

Contents.  Anterior  mediastinal  glands. 

The  middle  mediastinum  contains  the  pericardium  with  its 
contents,  the  phrenic  nerves  and  accompanying  vessels,  the 
arch  of  the  vena  azygos  major,  the  roots  of  the  lungs  and 
bronchial  lymphatic  glands. 

The  posterior  mediastinum  lies  behind  the  pericardium. 

Boundaries : — 

In  front.  Pericardium  and  roots  of  lungs,  and  diaphragm 
(below). 

Behind.  Spinal  column,  from  the  lower  border  of  the  4th 
dorsal  to  the  i2th  dorsal  vertebra. 

Laterally.  Pleura. 

Below.  Diaphragm  covered  by  pleura. 

Above.  Plane  passing  forwards  from  lower  border  of  4th 
dorsal  vertebra. 

Contents.  Descending  thoracic  aorta  and  some  of  its  right 
intercostal  branches,  ossophagus,  pneumogastric  and  great 
splanchnic  nerves,  the  three  azygos  veins,  thoracic  duct,  and 
posterior  mediastinal  glands. 


THE  HEART  AND  PERICARDIUM 

THE    PERICARDIUM. 

The  pericardium  is  a  nbro-serous  membrane,  containing 
the  heart  and  the  commencement  of  the  great  vessels.  The 
apex  points  upwards  and  surrounds  the  ascending  aorta, 
superior  vena  cava,  and  pulmonary  artery  for  about  2  inches 
— i.e.,  to  the  level  of  the  lower  border  of  the  aortic  arch. 
The  base  is  fixed  to  the  central  tendon  and  adjoining  muscular 
fibres  of  the  diaphragm. 

In  front.  Behtnd.  Laterally. 

Gladiolus.  Roots  of  lungs.  Pleura. 

Left    costal    car-      CEsophagus.  Comes  nervi  phre- 

tilages    (4th    to      Descending  aorta.          nici  vessels. 

yth).  Phrenic  nerve. 

Remains   of    thy- 

mus  gland. 
Overlapped  by 

both  lungs  and 

pleurae. 


THE  HEART  AND  PERICARDIUM  203 

The  serous  layer  of  the  pericardium  lines  the  inner  surface 
of  the  pericardium,  and  is  continued  on  to  the  surface  of  the 
heart,  being  also  prolonged  over  the  vessels  in  the  pericar- 
dium. The  aorta  and  pulmonary  artery  are  enclosed  in  one 
sheath,  and  it  surrounds  the  ends  of  the  four  pulmonary  veins, 
forming  a  pouch  posteriorly  between  the  veins  of  the  right 
and  left  sides.  The  part  of  the  superior  vena  cava  within  the 
pericardium  is  also  invested  by  it. 

The  serous  layer  forms  a  reduplicature  above  and  in  front  of 
the  root  of  the  left  lung,  enclosing  the  hbrous  remains  of  the 
left  superior  vena  cava  ;  it  reaches  from  the  left  superior  inter- 
costal vein  downwards  to  the  side  of  the  left  auricle,  where  it 
joins  the  serous  investment  round  the  left  upper  pulmonary 
vein.  This  reduplicature  is  known  as  the  vestigial  fold  of 
Marshall. 

THE    HEART. 

The  heart  is  a  hollow  muscular  organ  enclosed  in  the 
pericardium,  and  having  an  irregular  conical  shape.  It  is 
attached  at  its  base  to  the  great  bloodvessels,  being  otherwise 
free  within  the  pericardial  sac. 

Position. — The  heart  is  placed  obliquely,  the  base  being 
directed  upwards,  backwards,  and  to  the  right;  the  apex 
downwards,  forwards,  and  to  the  left.  The  apex  corresponds 
to  a  point  in  the  5th  left  intercostal  space  3^  inches  from  the 
mid-line. 

The  Limits  of  the  Heart. 

Superior.  Line  from  lower  border  of  2nd  left,  to  upper 
border  of  3rd  right  costal  cartilage. 

Inferior.  Line  from  yth  right  chondro-sternal  articulation  to 
apex. 

Right  side.  Line  drawn  nearly  vertically  i£  inches  from 
mid-line  of  sternum,  from  upper  to  lower  limit. 

Left  side.  Line  from  lower  border  of  2nd  left  costal  cartilage, 
i  inch  from  sternum,  downwards  and  to  the  left  to  apex. 

Position  of  the  Valves. 

Pulmonary.  Opposite  upper  border  of  3rd  left  costal  carti- 
lage near  sternum. 

Aortic.  Opposite  left  £  of  sternum,  on  level  with  lower 
border  of  3rd  costal  cartilage. 

Tricuspid.  Opposite  right  £  of  sternum,  on  level  with  4th 
intercostal  space 


204  THE  POCKET  ANATOMY 

Mitral.  Opposite  junction  of  4th  left  costal  cartilage  with 
sternum. 

Divisions. — The  heart  is  divided  longitudinally  by  a  septum 
into  two  halves,  right  and  left,  each  of  which  is  subdivided 
transversely  into  two  cavities.  Those  four  divisions  are 
indicated  on  the  heart's  surface  by  grooves.  Two  longitudinal 
grooves,  one  situated  on  the  anterior  and  the  other  on  the 
posterior  surface,  indicate  the  lateral  division,  whilst  a  trans- 
verse furrow,  the  auricula-ventricular  groove,  indicates  its  separa- 
tion into  auricles  above  the  furrow  and  ventricles  below  it. 

The  Circulation. — The  right  auricle  receives  venous  blood 
from  the  vense  cavae  and  coronary  sinus ;  thence  it  passes 
into  the  right  ventricle,  whence  it  is  conveyed  to  the  lungs  by 
the  pulmonary  artery.  After  being  oxygenized  the  blood 
passes  into  the  left  auricle  by  the  pulmonary  veins ;  thence  it 
is  conveyed  into  the  left  ventricle,  and  from  there  to  the  aorta, 
whence  it  passes  through  the  body. 

THE   CAVITIES   OF   THE    HEART. 

The  RIGHT  AURICLE  consists  of  a  principal  cavity  and  an 
appendix  auriculae. 

The  principal  cavity,  or  sinus  venosus,  is  of  an  irregular 
form. 

The  appendix  auricula  is  a  small  muscular  pouch  projecting 
from  the  anterior  and  upper  angle  of  the  auricle  overlapping 
the  root  of  the  pulmonary  artery. 

At  the  junction  externally  of  the  two  cavities  is  seen  a 
well-marked  groove  (sulcus  terminalis),  which  on  the  interior 
appears  as  a  ridge  (crista  terminalis  of  His) . 

Openings  in  the  sinus. — Superior  vena  cava,  in  the  upper 
and  front  part.  Inferior  vena  cava,  at  the  lower  and  back 
part  of  the  auricle.  Between  the  openings  of  the  two  cavae  is 
a  muscular  projection,  the  tubercle  of  Lower. 

The  coronary  sinus  opens  between  the  inferior  vena  cava  and 
the  auric ulo-ventricular  opening. 

Foramina  Thebesii  are  the  mouths  of  small  cardiac  veins. 

The  auricula-ventricular  opening  is  in  front  of  the  inferior 
cava. 

Openings  of  anterior  cardiac  veins  (2  or  3)  from  the  surface  of 
the  right  ventricle. 

Valves. — The  Eustachian  valve  is  a  semilunar  fold  of  endo- 
cardium in  front  of  the  anterior  margin  of  the  inferior  vena 
cava ;  passes  upwards  and  to  the  left  to  anterior  margin  of 
annulus  ovalis. 


THE  HEART  AND  PERICARDIUM  205 

The  coronary  valve,  or  valve  of  Thcbesius,  protects  the  open- 
ing of  the  coronary  sinus. 

Remnants  of  foetal  structures. — The  Fossa  ovalis  is  the 
remains  of  the  foramen  ovale  on  the  lower  and  posterior  part 
of  the  septum  auricularum,  just  above  and  to  the  left  of  the 
opening  of  the  inferior  vena  cava. 

The  annulus  ovalis  is  the  upper  crescentic  elevated  margin 
of  the  fossa. 

The  musculi  pectinati  are  the  prominent  muscular  columns 
running  over  the  surface  of  the  appendix  auriculae. 

The  endocardium  is  smooth  in  the  main  part  of  the 
cavit)',  but  irregular  over  the  musculi  pectinati  of  the  auricu- 
lar appendix. 

The  RIGHT  VENTRICLE  consists  of  a  cavity,  the  upper  and 
left  angle  of  which  is  prolonged  into  a  funnel-shaped  canal, 
the  infundibulum  or  conus  arteriosus,  leading  to  the  pulmonary 
artery.  On  the  wall  (except  in  the  infundibulum,  which  is 
smooth)  are  projections,  column®  carnea,  formed  of  muscular 
bundles,  of  which  there  are  three  varieties  :  the  first  are 
merely  prominent  ridges  ;  the  second  are  attached  at  the  ends, 
being  free  in  the  middle  ;  the  third  are  the  musculi  papillares, 
which  project  inwards,  and  are  attached  by  their  bases  to  the 
wall  of  the  ventricle,  the  other  end  being  connected  with  the 
chorda  tendinea,  or  cords  attached  to  the  flaps  of  the  auriculo- 
ventricular  valve. 

The  tricuspid  valve,  which  guards  the  right  auriculo-ventricu- 
lar  opening,  consists  of  three  cusps,  formed  by  a  reduplication 
of  the  endocardium,  with  some  fibrous  tissue  enclosed.  The 
bases  of  the  flaps  are  attached  to  the  fibrous  ring  of  the 
auriculo- ventricular  orifice,  while  to  their  free  ends  are 
attached  the  chordae  tendineae. 

Position  of  cusps.  Right  one  against  right  wall  of  ventricle 
(marginal  cusp).  Posterior  one  between  auriculo-ventricular 
opening  and  septum  (septal  cusp).  Left  between  auriculo 
ventricular  and  pulmonary  orifices  (infundibular  cusp).  The 
valve  prevents  regurgitation  of  blood  into  the  auricle  during 
the  heart's  contraction. 

The  opening  of  the  pulmonary  artery  is  at  the  summit  of  the 
funnel-shaped  infundibulum,  and  is  guarded  by  the  pulmonary 
semilunar  valves.  The  semilunar  valves  are  three  folds  of 
the  lining  membrane,  aright,  left,  and  posterior,  which  guard 
the  orifice  of  the  pulmonary  artery.  The  free  margin  of  each 
has  in  its  middle  a  small  fibrous  nodule,  the  corpus  Arantii, 
and  between  each  valve  and  the  beginning  of  the  pulmonary 
artery  is  a  dilatation  called  the  pulmonary  sinus,  or  sinus  of 


206  THE  POCKET  ANATOMY 

Valsalva.  The  point  corresponding  externally  to  these  valves 
is  the  upper  border  of  the  junction  of  the  third  left  costal 
cartilage  with  the  sternum. 

The  LEFT  AURICLE  consists  of  a  principal  cavity  and  an 
appendix  auriculae ;  the  latter  extends  forwards  and  to  the 
right  side,  projecting  over  the  commencement  of  the  pul- 
monary artery.  Its  interior  presents  musculi  pectinati  as  on 
the  right  side. 

OPENINGS. — The  pulmonary  veins  (4)  open  into  the  cavity, 
two  on  either  side. 

The  auricula-ventricular  opening  is  smaller  than  that  on  the 
right  side. 

On  the  septum  may  be  seen  a  shallow  depression,  the  re- 
mains of  the  foramen  ovale. 

The  LEFT  VENTRICLE  is  longer  and  more  conical  than  the 
right,  with  its  walls  nearly  three  times  as  thick.  The  interior 
contains  columnae  carneae,  musculi  papillares,  and  chordae 
tendineae,  as  on  the  right  side. 

OPENINGS. — The  auricula-ventricular  opening  corresponds  to 
the  junction  of  4th  left  costal  cartilage  with  the  sternum  ;  it  is 
closed  by  the  mitral  valve,  which  is  attached  to  the  circum- 
ference at  the  opening,  similarly  to  the  tricuspid.  It  consists 
of  two  flaps,  the  larger  being  anterior  (aortic  cusp). 

The  aortic  opening  is  placed  in  front  and  to  the  right  side  of 
the  preceding,  and  its  position  may  be  marked  externally  by 
a  line  drawn  through  left  half  of  the  sternum,  on  a  level  with 
the  lower  border  of  the  3rd  left  costal  cartilage.  The  orifice 
is  guarded  by  three  semilunar  valves,  which  are  precisely 
similar  to  those  on  the  pulmonary  artery,  the  characteristics 
of  which  are,  however,  better  marked  ;  they  are  named  from 
their  position  anterior,  right  posterior  and  left  posterior. 

The  endocardium  is  the  serous  membrane  lining  the  whole 
of  the  interior  of  the  heart,  and  is  continuous  with  the  lining 
membrane  of  the  bloodvessels. 

The  coronary  arteries  supply  the  substance  of  the  heart. 

The  right  coronary  artery  comes  off  from  the  anterior  sinus 
of  Valsalva  (aortic),  passes  on  the  right  side  of  the  pulmonary 
artery,  between  it  and  the  right  appendix,  then  backwards 
along  the  right  auriculo-ventricular  groove  as  far  as  the 
posterior  inter-ventricular  groove,  where  it  divides  into  two 
branches,  one  of  which  passes  transversely  in  the  left  auriculo- 
ventricular  groove  and  joins  branch  of  left  artery,  whilst  the 
other  passes  downwards  in  the  posterior  inter-ventricular 
groove  to  supply  the  ventricles  and  septum ;  anas  descending 
branch  of  left  artery 


ORGANS  OF  VOICE  AND  RESPIRATION       207 

The  left  coronary  artery  arises  from  the  left  posterior  sinus 
of  Valsalva.  It  passes  behind  and  then  to  the  left  of  the  pul- 
monary artery,  and  divides  it  into  two  branches,  one  of  which 
passes  forwards  and  downwards  in  the  anterior  inter-ventri- 
cular groove,  and  the  other  to  the  left  and  backwards  along 
the  left  auriculo-ventricular  groove. 

The  cardiac  veins  return  the  blood  from  the  muscular 
wall  mainly  through  the  coronary  sinus  into  the  right 
auricle  (p.  106). 

The  nerves  come  from  the  cardiac  plexuses. 


ORGANS  OF  VOICE  AND  RESPIRATION. 

THE    LARYNX. 

The  larynx  lies  in  the  front  and  upper  part  of  the  neck, 
being  placed  below  the  tongue  and  hyoid  bone  and  between 
the  large  vessels  of  the  neck.  It  opens  above  into  the  pharynx 
and  below  into  the  trachea.  It  is  subcutaneous  in  the  middle 
line,  being  covered  only  by  skin  and  cervical  fascia ;  but 
laterally  it  is  overlaid  by  the  insertions  of  the  sterno-hyoid 
and  sterno-thyroid,  by  the  thyro-hyoid  and  origin  of  the 
inferior  constrictor.  Is  composed  of  cartilages  held  together 
by  ligaments,  and  moved  by  muscles,  the  whole  being  lined 
with  mucous  membrane. 

The  cartilages  of  the  larynx  : — 

The  thyroid  cartilage  is  the  largest,  consists  of  two  wings 
or  alae  united  in  front  at  an  acute  angle,  and  forming  the 
projection  known  as  the  pomum  Adami. 

Outer  surface :  traversed  by  oblique  line,  passing  upwards 
and  backwards,  giving  attachment  to  sterno-thyroid  and 
Ihyro-hyoid  muscles,  and  below  oblique  line  to  inferior 
constrictor. 

Inner  surface :  presents  in  the  middle  line  at  the  junction  of 
right  and  left  ala,  the  receding  angle,  to  which  are  attached  the 
root  of  the  epiglottis,  the  superior  and  inferior  thyro-aryte- 
noid  ligaments,  the  thyro  -  arytenoidei  and  thyro-epiglottidei 
muscles. 

Superior  border ;  sinuous ;  connected  to  hyoid  bone  by 
thyro-hyoid  membrane  ;  the  two  meeting  together  anteriorly 
in  the  mid-line  form  notch  above  pomum  Adami. 

Inferior  border :  connected  with  upper  border  of  cricoid  by 
crico- thyroid  membrane  anteriorly,  and  by  crico-thyroid 
muscle  laterally. 

Posterior  border :  thick  and  rounded,  receives  insertion  of 


2o8  THE  POCKET  ANATOMY 

stylo-  and  palato-pharyngei  muscles,  prolonged  upwards  into 
superior  cornu,  which  passes  up  wards,  backwards,  and  inwards, 
having  lateral  thyro-hyoid  ligament  attached  to  tip ;  and 
downwards  into  inferior  cornu,  shorter,  passing  downwards, 
forwards,  and  inwards,  presenting  on  inner  surface  a  small 
facet  to  articulate  with  cricoid. 

The  cricoid  cartilage  :  shaped  like  signet  ring,  deep  behind 
and  shallow  in  front. 

Outer  surface:  anterior  half  gives  attachment  to  crico- 
thyroid  muscles,  and  behind  this  to  part  of  inferior  con- 
strictor. Posterior  half,  broad  and  thick,  presents  ridge  in 
middle  line  for  attachment  of  some  longitudinal  fibres  of 
oesophagus  ;  on  each  side  of  ridge,  a  depression  giving  attach- 
ment to  the  crico-arytenoideus  posticus,  and  external  to  this 
a  small  facet  for  articulation  with  inferior  cornu  of  thyroid. 

Inner  surface :  smooth,  lined  with  mucous  membrane. 

Superior  border  :  inclines  from  the  front,  upwards  and  back- 
wards, gives  attachment  anteriorly  and  laterally  to  crico- 
thyroid  membrane  and  crico-arytenoideus  lateralis.  Presents 
posteriorly  in  mid-line  a  notch,  on  each  side  of  which  is  a 
facet  for  articulation  with  arytenoid  cartilage. 

Inferior  border:  horizontal,  connected  with  ist  ring  of 
trachea  by  intervening  membrane. 

Arytenoid  cartilages :  are  two  small  pyramidal  cartilages, 
articulating  with  posterior  part  of  upper  border  of  cricoid. 

Antero-external  surface :  convex  and  rough,  receives  attach- 
ment of  thyro-arytenoideus  muscle  and  false  vocal  cord.  At 
upper  end  is  a  tubercle  for  superior  thyro-arytenoid  ligament, 
and  below  an  oblique  ridge. 

Posterior  surface :  hollowed  for  attachment  of  arytenoideus 
muscle. 

Internal  surface :  narrow  and  smooth,  covered  with  mucous 
membrane. 

Base :  has  concave  facet  on  under  surface  for  articulation 
with  cricoid  cartilage,  and  prolonged  into  three  angles. 

External  or  muscular  process :  short  and  prominent,  gives 
attachment  to  lateral  and  posterior  crico-arytenoid  muscles. 

Anterior  or  vocal  process  :  long  and  pointed,  gives  attach- 
ment to  true  vocal  cord. 

Internal :  rounded. 

Apex :  looks  backwards  and  inwards,  surmounted  by  the 
cartilage  of  Santorini. 

Cartilages  of  Santorini  or  cornicula  laryngis :  two  small 
cartilages-  of  conical  shape,  each  attached  to  the  apex  of  an 
arytenoid  cartilage,  and  giving  attachment  to  the  aryteno- 
epiglottidean  fold. 


ORGANS  OF  VOICE  AND  RESPIRATION       209 

Cuneiform  cartilages,  or  cartilages  of  Wrisberg,  are  two 

small  cartilages,  one  on  each  side,  found  in  the  aryteno- 
epiglottidean  fold. 

The  epiglottis  covers  the  superior  aperture  of  the  larynx  ; 
it  is  a  leaf-shaped  lamina  of  yellow  nbro-cartilage. 

Apex:  attached  to  receding  angle  of  thyroid  by  thyro 
epiglottic  ligament. 

Base  :  broad,  rounded,  and  free  ;  directed  upwards. 

Anterior  surface:  covered  in  upper  part  by  mucous  mem- 
brane, which  passes  forwards  as  the  three  glosso-epiglottic 
folds  to  connect  it  with  the  tongue ;  below  it  is  attached  to 
the  hyoid  bone  by  hyo-epiglottic  ligament. 

Posterior  surface :  covered  by  mucous  membrane,  concave 
from  side  to  side,  concavo-convex  from  above  downwards; 
the  convex  part  is  known  as  the  cushion  or  tubercle  of  the 
epiglottis. 

The  LIGAMENTS  of  the  larynx  are  : — 

The  thyro-hyoid  membrane  :  passes  from  the  upper  border 
of  the  thyroid  cartilage  to  the  upper  border  of  the  posterior 
surface  of  the  hyoid  bone:  between  it  and  the  posterior 
surface  of  the  hyoid  bone  is  a  synovial  bursa.  It  is  pierced 
by  the  superior  laryngeal  vessels  and  internal  laryngeal  nerve 
of  each  side. 

(The  lateral  thyro-hyoid  membrane  is  the  posterior  edge  of 
the  preceding,  passes  from  the  superior  cornu  of  the  thyroid 
to  the  tip  of  the  great  cornu  of  the  hyoid  bone,  in  which  is 
found  a  small  cartilaginous  nodule,  the  cartilage  triticea.) 

The  crico-thyroid  membrane  connects  the  thyroid  and 
cricoid  cartilages.  Consists  of  two  parts  : — 

Central:  thick,  triangular,  with  base  down  wards,  passingfrom 
lower  border  of  thyroid  to  upper  border  of  cricoid  cartilage. 

Lateral :  thinner,  passes  from  upper  border  of  cricoid  car- 
tilage internally  to  ala  of  thyroid,  ending  in  a  free  border, 
the  true  vocal  cord,  or  inferior  thyro-arytenoid  ligament. 

The  superior  thyro  -  arytenoid  ligaments  are  attached 
anteriorly  to  the  angle  between  the  alae  of  the  thyroid 
cartilage,  just  below  the  epiglottis,  and  posteriorly  to  the 
anterior  surface  of  the  arytenoid  cartilage.  They  lie  within 
the  mucous  membrane,  forming  the  false  vocal  cords. 

The  inferior  thyro-arytenoid  ligaments  are  attached  an- 
teriorly to  the  angle  between  the  alae  of  the  thyroid  cartilage, 
and  posteriorly  to  the  anterior  process  at  the  base  of  the 
arytenoid  cartilage.  The  inner  free  edge,  covered  with 
mucous  membrane,  forms  the  true  vocal  cord,  and  below  it  is 
continuous  with  the  lateral  part  of  the  crico-thyroid  ligament. 


210  THE  POCKET  ANATOMY 

Capsular  ligaments,  lined  with  synovial  membrane,  sur- 
round the  articulations  between  the  cricoid  and  inferior 
cornua  of  the  thyroid,  and  also  between  the  cricoid  and  two 
arytenoid  cartilages. 

The  hyo-epiglottic  ligament  connects  the  lower  part  of  the 
anterior  surface  of  the  epiglottis  to  the  upper  border  of  hyoid 
bone. 

The  thyro-epiglottic  ligament  connects  the  apex  of  the 
epiglottis  to  the  upper  part  of  the  receding  angle  of  the 
thyroid  cartilage. 

THE  INTERIOR  OF  THE  LARYNX. 

The  cavity  of  the  larynx  extends  from  the  superior  aperture 
to  the  lower  border  of  the  cricoid  cartilage.  The  vocal  cords 
form  an  imperfect  diaphragm,  dividing  the  cavity  into  two 
parts.  The  chink  between  the  true  vocal  cords  is  the  glottis 
or  rima  glottidis,  which  is  the  narrowest  part  of  the  larynx. 
The  whole  is  lined  by  mucous  membrane. 

The  superior  aperture  of  the  larynx  is  triangular  in  shape. 
with  base  directed  forwards.  In  front  is  the  epiglottis, 
behind  are  the  summits  of  the  arytenoid  cartilages  and 
cornicula,  and,  laterally,  the  aryteno-epiglottic  folds  pass 
between  the  lateral  edges  of  the  epiglottis  backwards  to  the 
tips  of  the  arytenoid  cartilages  and  cornicula,  enclosing  the 
cuneiform  cartilages. 

The  superior  or  false  vocal  cords,  one  on  each  side,  are 
two  folds  of  mucous  membrane  enclosing  the  superior  thyro- 
arytenoid  ligaments  ;  each  is  placed  above  the  corresponding 
ventricle. 

The  inferior  or  true  vocal  cords,  one  on  each  side,  are 
attached  in  front  to  the  receding  angle  of  the  thyroid  carti- 
lage, and  behind  to  the  anterior  angle  or  vocal  process  at  the 
base  of  the  arytenoid  cartilage.  They  are  formed  of  mucous 
membrane,  enclosing  the  inferior  thyro-arytenoid  ligaments. 

The  ventricles  of  the  larynx  are  the  fossae  between  the  false 
and  true  vocal  cords ;  the  anterior  part  of  each  ventricle  is 
prolonged  upwards  between  the  false  vocal  cord  and  the 
ala  of  the  thyroid  cartilage  into  a  pouch,  the  sacculus  laryngis. 
The  opening  of  the  sacculus  into  the  ventricle  is  narrow,  and 
its  cavity  contains  numerous  small  glands. 

The  muscles  of  the  larynx  have  been  described  (vide 
pp.  30  and  31). 

The  arteries  of  the  larynx  are  the  laryngeal  branches  of 
the  superior  and  inferior  thyroid. 


ORGANS  OF  VOICE  AND  RESPIRATION        211 

The  nerves  are  the  superior  laryngeal,  the  inferior  or 
recurrent  laryngeal,  and  branches  of  the  sympathetic  of 
each  side. 


THE    TRACHEA. 

The  trachea  extends  from  the  lower  border  of  the  larynx 
(opposite  the  lower  border  of  5th  cervical  vertebra)  to 
the  level  of  the  disc  between  the  4th  and  5th  dorsal  vertebrae, 
there  dividing  into  the  two  bronchi.  In  length  it  measures 
4^  inches. 

Relations  in  the  Neck. 


In  front. 
Skin. 

Superficial  and  deep  fasciae. 
Anastomosis      of      anterior 
jugular  veins. 


Isthmus  of  thyroid  gland. 
Inferior  thyroid  veins. 


Laterally. 

Cervical  fascia. 

Common  carotid 
artery. 

Lateral  lobe  of 
thyroid  gland. 

Inferior  thyroid 
artery. 

Recurrent  laryn- 
geal nerve. 


Behind. 
QEsophagrs. 


In  the  Thorax. 


In  Front.  Right  Side. 

Manubrium     Right     pneumo- 
sterni.  gastric  nerve. 

Innominate      ar- 


tery. 
Pleura. 


Left  Side. 
Left  cardiac  nerves. 
Left  pneumogastric 

nerve. 
Left  recurrent 

laryngeal  nerve. 
Aortic  arch. 
Left  subclavian  m- 

tery. 
Pleura. 


Posteriorly. 

(Esophagus. 


Origin    of    sterno 

mastoid. 
Origins  of  sterno- 

t  hy  roid     and 

sterno-hyoid. 
Remains  of  thymus 

gland. 
Left       innominate 

vein. 
Commencements  of 

innominate     and 

left    carotid    ar- 
teries. 

Arch  of  aorta. 
Deep      cardiac 

plexus. 

The  cartilages,  from  sixteen  to  twenty  in  number,  are 
U-shaped,  the  anterior  §  or  convex  part  being  cartilage,  the 
posterior  j  fibrous  membrane. 

14—2 


212  THE  POCKET  ANATOMY 

The  right  bronchus,  about  i  inch  long,  is  shorter,  more 
vertical  in  direction,  and  of  larger  calibre  than  the  left. 
It  passes  from  the  trachea  downwards  and  to  the  right  on  a 
level  with  the  5th  dorsal  vertebra  to  the  root  of  the  corre- 
sponding lung,  lying  at  first  above  and  then  behind  the  right 
pulmonary  artery.  The  superior  vena  cava  and  right  phrenic 
nerve  lie  in  front,  and  the  venaazygos  major  arches  forwards 
above  it. 

The  left  bronchus  is  nearly  2  inches  long,  and  passes  down- 
wards and  forwards  under  the  arch  of  the  aorta  to  the  root  of 
the  left  lung,  joining  it  at  the  level  of  the  upper  border  of  6th 
dorsal  vertebra.  Behind  it  are  the  oesophagus,  thoracic  duct, 
and  descending  aorta.  It  lies  at  first  behind,  and  then  below, 
the  left  pulmonary  artery. 

THE  LUNGS  AND  THE  PLEURAE. 

The  lungs,  two  in  number,  occupy  the  whole  of  the  thorax 
except  the  mediastina  (vide  pp.  201  and  202),  which  separate 
them  from  each  other.  They  are  conical  in  shape,  and  are 
covered  with  pleura.  Each  lung  is  free  except  at  the  median 
part  or  root,  where  it  is  attached  to  the  bloodvessels  and 
bronchi. 

The  pleurae  are  two  serous  sacs  enclosing  and  investing  the 
lungs.  Each  pleura  consists  of  a  visceral  and  parietal  layer. 
The  visceral  portion  covers  the  lung,  and  the  parietal  layer  lines 
the  inner  surface  of  the  chest  walls,  the  upper  surface  of  the 
diaphragm,  and  the  sides  of  the  pericardium.  The  visceral 
layer  of  each  pleura  becomes  continuous  with  the  parietal 
layer  in  front  and  behind  the  root  of  the  lung  ;  and  below 
the  root  a  fold,  the  ligamentum  latum  pulmonis,  extends  down- 
wards along  the  inner  surface  of  the  lung  to  the  diaphragm. 
The  mediastina  are  formed  by  the  visceral  layers  of  each  side 
approaching  one  another  towards  the  median  line. 

The  limits  of  the  parietal  pleurae  are  as  follows:  each 
extends  upwards  into  the  neck,  forming  a  dome-like  process 
over  the  apex  of  the  lung  about  2  inches  above  the  anterior 
end  of  the  first  rib ;  from  this  each  pleura  passes  down- 
wards and  forwards  to  the  posterior  aspect  of  the  sterno- 
clavicular  joint  and  meets  its  fellow  in  the  mid-line  at  the 
manubrio-gladiolar  articulation  ;  they  pass  down  together  to 
level  of  4th  costal  cartilages,  where  right  pleura  passes  verti- 
cally to  level  of  yth  right  costal  cartilage  in  mid-line ;  then 
outwards,  crossing  gth  rib  in  mid-axillary  line ;  then  down- 
wards and  backwards  along  nth  rib  to  reach  spine  at  neck  of 


ORGANS  OF  VOICE  AND  RESPIRATION       213 

rath  rib.  Behind,  it  passes  upwards  on  right  side  of  bodies  of 
vertebras  to  apex.  At  level  of  4th  costal  cartilage  the  left  pleura 
arches  outwards,  leaving  uncovered  part  of  anterior  surface 
of  pericardium,  and  lying  about  f  inch  from  the  margin  of 
sternum,  to  reach  yth  left  costal  cartilage,  below  which  it 
follows  same  line  as  on  right,  but  is  placed  at  a  slightly  lower 
level. 

THE  LUNGS. 

Each  lung  is  cone-shaped,  with  the  base  downwards. 

The  apex  projects  upwards  into  the  root  of  the  neck  behind 
the  clavicle  and  anterior  scalene  muscle.  Above  the  first 
rib,  the  first  part  of  the  subclavian  artery  lies  in  front,  being 
separated  from  it  by  the  pleura. 

The  base  is  concave,  resting  upon  the  diaphragm,  and 
following  the  attachment  of  the  midriff  is  placed  lower  ex- 
ternally and  posteriorly  than  anteriorly. 

The  outer  surface  is  convex,  and  corresponds  to  the  chest 
wall. 

The  inner  surface  is  concave,  corresponding  in  part  to  the 
convex  outer  surface  of  the  pericardium.  It  presents  about 
its  middle,  and  towards  the  posterior  part,  a  slit,  the  hilum 
pulmonis,  where  the  bronchi  and  vessels  pass  in  to  form  the 
root. 

The  anterior  margin  is  thin,  and  overlaps  the  pericardium, 
and  presents  on  the  left  side  a  notch  for  the  apex  of  the 
heart. 

The  posterior  margin  is  rounded,  and  occupies  the  groove  by 
the  side  of  the  vertebrae. 

Fissures  and  Lobes. — The  left  lung  is  smaller  and  narrower 
than  the  right,  and  is  divided  into  an  upper  and  lower  lobe 
by  a  fissure,  which  passes  upwards  and  backwards  from  the 
anterior  border  nearly  to  the  root.  The  right  lung  is  larger 
and  shorter  than  the  left,  and  is  divided  into  three  lobes, 
upper,  middle,  and  lower,  by  two  fissures.  One  fissure  passes 
obliquely  from  the  outer  surface  upwards  and  inwards  nearly 
to  the  root,  and  the  second  passes  horizontally  from  the 
middle  of  the  first,  forwards  to  the  anterior  margin,  cutting 
off  a  middle  triangular  lobe. 

Each  root  consists  of  the  corresponding  bronchus,  a  branch 
of  the  pulmonary  artery,  two  pulmonary  veins,  nutritive 
bronchial  vessels,  anterior  and  posterior  pulmonary  plexuses, 
lymphatic  vessels  and  glands,  all  held  together  by  areolar 
tissue,  and  covered  by  the  pleura. 


2i4  THE  POCKET  ANATOMY 

Relations  of  the  right  root : — 

In  Front.  Behind.                   Atm*.                   Below. 

Right   phrenic  Right  pneumogas-  Vena  azygos        Ligament -.im 

nerve.  trie  nerve.  major.                       latum     pu:. 

Superior  vena  cava.  Vena  azygos  major.                                      m  o  n  i  s. 
Part    of  right 

auricle. 

Relations  of  the  left  root : — 

In  Front.                          Behind.                   Above.  Below. 

Left  phrenic  nerve.         Descending    thoracic  Arch    of  Ligamenturr 

aorta.                                aoita,  latum     pul- 

CEsophagus.  munis. 
Thoracic  duct. 
Left     pneumogastric 


Position  of  the  constituents  of  the  root : — 
From  before  backwards  in  each  lung : — 
Pulmonary  veins. 
Pulmonary  artery. 
Bronchus. 

From  above  downwards :— - 

Right  side.  Left  side. 

Bronchus.  Pulmonary  artery. 

Pulmonary  artery.  Bronchus. 

Pulmonary  veins.  Pulmonary  veins. 


THE  PULMONARY  ARTERY. 

The  pulmonary  artery  conveys  venous  blood  from  the  right 
side  of  the  heart  to  the  lungs.  It  is  2  inches  long,  and  com- 
mencing at  the  infundibulum  of  the  right  ventricle,  is  directed 
upwards  in  front  of  ascending  part  of  aorta,  and  in  same  tube 
of  pericardium,  then  passes  upwards  and  backwards  on  left 
of  ascending  aorta  to  reach  the  concavity  of  the  aortic  arch, 
where  it  divides  into  right  and  left  branches  for  the  lungs. 
Near  the  bifurcation  a  fibrous  cord,  the  ligamentwn  arteriosum, 
passes  from  the  left  branch  to  the  under  surface  of  the  aorta. 
It  is  the  remains  of  the  ductus  arteriosus  in  the  foetus. 

Relations  (contained  in  same  sheath  of  pericardium  with 
ascending  aorta) : — 


DUCTLESS  GLANDS  ON  THE  TRACHEA        215 


In  Front. 
Pericardium. 
Left  pleura  and 
lung. 

Behind. 
Ascending  aorta. 
Left  auricle. 

Above. 
Transverse  aorta. 
Ligamentum    ar- 
teriosum. 

Laterally. 
Coronary  artery. 
Auricular  appen- 
dix. 
Ascending  aorta 
(right  side). 

The  right  pulmonary  artery  is  longer  than  the  left,  passes 
to  the  root  of  the  right  lung,  behind  the  ascending  aorta  and 
superior  vena  cava,  where  it  divides  into  three  primary 
branches,  one  for  each  lobe. 

The  left  pulmonary  artery  is  connected  at  origin  with  arch 
of  aorta  by  ligamentum  arteriosum,  and  passes  in  front  of 
the  descending  aorta  and  left  bronchus  to  the  root  of  the  left 
lung,  there  dividing  into  two  primary  branches  for  the  two 
lobes. 

DUCTLESS  GLANDS  ON  THE  TRACHEA. 

THE    THYROID    GLAND. 

The  thyroid  gland  is  situated  on  the  upper  part  of  the 
trachea,  and  consists  of  two  lateral  lobes  united  at  lower  part 
by  neck  or  isthmus,  which  lies  over  2nd,  3rd,  and  4th  rings 
of  trachea  and  is  covered  by  skin,  superficial  and  deep  fasciae, 
and  anterior  jugular  veins. 

Each  lobe  is  conical,  with  smaller  end  upwards. 

Dimensions.  Vertical,  i£  inches ;  transverse,  £  inch ;  thick, 
£  inch. 

Relations : — 

Antero-external  (convex),  surface.  Deep  cervical  fascia,  sterno- 
mastoid,  sterno  -  thyroid,  sterno  -  hyoid,  and  omo-hyoid 
muscles. 

Postero-internal  (concave),  surface.  Upper  six  rings  of  trachea, 
cricoid  and  thyroid  (below  oblique  line),  crico-thyroid  and 
inferior  constrictor  muscles,  inferior  thyroid  artery,  recurrent 
laryngeal  and  external  laryngeal  nerves,  oesophagus  (on  left 
side) . 

Postero-external  (convex]  surface.     Sheath  of  carotid  vessels. 

Vessels.  Arteries,  superior  and  inferior  thyroid ;  veins, 
superior,  middle,  and  inferior  thyroid. 

THE   THYMUS   GLAND. 

The  thymus  gland  attains  its  full  size  at  two  years,  after 
which  it  gradually  shrinks  away.  It  is  situated  partly  in  the 
anterior  mediastinum,  and  partly  in  the  neck,  reaching  from 
level  of  4th  costal  cartilage  upwards  on  trachea  as  high  as 


216  THE  POCKET  ANATOMY 

lower  border  of  thyroid  gland.  It  consists  of  two  lateral  lobes 
with  occasionally  a  middle  connecting  one. 

Relations  in  early  life : — 

Base.  Pericardium. 

Behind.  Trachea,  pericardium,  and  great  thoracic  vessels. 

In  front.  Sternum  as  low  as  4th  costal  cartilages,  origins  of 
sterno-hyoid  and  sterno- thyroid  muscles. 

Externally.  Pleura,  sheath  of  carotid. 

Internally.  Opposite  lobe  and  side  of  trachea. 


THE  URINARY  ORGANS. 

THE    KIDNEYS. 

The  kidneys  secrete  the  urine,  and  are  situated  for  the 
most  part  in  the  hypochondriac  and  epigastric  regions  of 
the  abdomen  behind  the  peritoneum,  extending  from  the 
nth  rib  to  within  an  inch  of  the  crista  ilii,  the  right  being 
placed  lower  than  the  left,  and  lying  slightly  in  the  right 
lumbar  and  umbilical  regions.  The  average  length  of  each 
kidney  is  4  inches,  breadth  2  inches,  and  thickness  i  inch. 
Weight  4^  ounces. 

Relations. — The  relations  of  the  two  kidneys  differ  some- 
what ;  each  is  placed  so  that  its  anterior  surface  looks  out- 
wards and  the  posterior  inwards,  the  upper  end  being  nearer 
the  mid-line  than  the  lower.  Each  kidney  is  covered  partly 
on  its  anterior  surface  by  peritoneum. 

Relations  of  the  Right  Kidney. 
In  front.  Behind. 

Right  lobe  of  liver.  Diaphragm, 

znd  part  of  duodenum.  Quadratus  lumborum. 

Hepatic  flexure  of  colon.  Psoas. 

(Of    which    the    last    two       Fasciae  covering  these 
areas  are  non-»peritoneal.)  muscles. 

Anterior  lamella  of  lumbar 

aponeurosis. 
Last  dorsal.          \ 
Ilio-hypogastric,  I  Nerves. 

ilio- inguinal,  J 
ist  lumbar  artery. 
Pleura. 

Last    intercostal   space   and 
I2th  rib. 


THE  URINARY  ORGANS  217 

Relations  of  the  Left  Kidney. 

In  front.  Behind. 

Fundus  of  stomach.  As  on  right,  except  that  left 

Fostero-internal    surface    of          kidney,  lying  rather  higher, 
spleen.  lies  over  nth  rib. 

Tail  of  pancreas. 

Descending  colon. 

(Of  which  last  two  are  non- 
peritoneal.)  9 

Above  each  kidney  is  the  supra-renal  body. 

Below  each  kidney  is  the  iliac  crest. 

The  external  border  is  convex,  and  is  directed  outwards  and 
backwards. 

The  internal  border  is  concave,  directed  well  forwards,  and 
at  the  centre  is  the  fissure  or  hilum,  where  the  vessels  enter 
and  the  ureter  leaves,  lying  from  before  backwards  as  follows  : 
renal  vein,  renal  artery,  ureter. 

Each  kidney  is  connected  with  the  bladder  by  a  ureter, 
which  serves  to  convey  urine  to  the  latter  viscus ;  the  top 
of  each  ureter  is  expanded,  and  forms  the  pelvis  of  the  kidney, 
which  is  divided  into  three  parts  called  infundibnla,  which 
are  subdivided  into  about  12  calyces.  Into  these  calyces  small 
papilla  project,  which  are  the  apices  of  the  pyramids  of 
Malpighi.  These  latter  form  the  medullary  substance  of 
the  kidney,  and  are  imbedded  in  the  cortical  substance,  which 
encloses  them  completely  except  at  the  papillae. 

SUPRA-RENAL   CAPSULES. 

These  are  ductless  glands,  resembling  in  shape  a  cocked 
hat,  and  which  embrace  the  upper  extremity  of  each  kidney. 
The  right  usually  has  no  peritoneum  in  front,  but  the  left  is 
covered  in  front  by  peritoneum,  except  where  the  pancreas 
crosses  it. 

Relations : — 

A  nteriorly — Right.  Liver,  inferior  vena  cava,  and  duodenum. 
Left.  Stomach  and  lesser  sac  of  peritoneum,  pancreas  and 
spleen. 

Posteriorly.  Diaphragm. 

Below.  Top  of  kidney. 

THE    URETERS. 

The  ureters  connect  the  kidneys  with  the  bladder,  forming 
the  excretory  ducts  of  the  former,  12  to  14  inches  long. 


2i8  THE  POCKET  ANATOMY 

Relations  of  the  Ureter  in  the  Abdomen. 

Behind.  In  front. 

Psoas.  Peritoneum. 

Genito-crural  nerve.  Colic  vessels. 

Common    or    external    iliac       Spermatic  vessels, 
artery.  Ileum  (right  side). 

Pelvic  colon  (left  side). 

The  right  ureter  lies  close  to  the  outer  side  of  the  inferior 
vena  cava. 

in  the  pelvis. 

In  the  Male.—  Each  ureter  enters  the  fold  of  peritoneum 
limiting  laterally  the  recto  -  vesical  pouch  (posterior  false 
ligament  of  bladder)  and  reaches  the  base  of  the  bladder, 
below  which  it  runs  downwards  and  forwards  under  the 
obliterated  hypogastric  artery,  crossing  the  vas  deferens 
externally  ;  it  reaches  bladder  2  inches  from  its  fellow  and 
the  same  distance  from  prostate  ;  finally  it  enters  the  interiro 
of  the  bladder  by  passing  very  obliquely  through  its  coats  at 
the  posterior  angle  of  the  base. 

In  the  Female. — Passes  in  posterior  false  ligament  of  uterus, 
over  side  of  cervix  below  uterine  artery  and  lateral  to  upper 
part  of  vagina,  to  posterior  part  of  base  of  bladder,  and  ends 
as  in  the  male. 

THE    BLADDER. 

The  bladder  receives  the  urine  from  the  kidneys  by  the 
ureters. 

Position. — In  infancy  it  lies  partly  in  the  abdomen.  In  the 
adult  it  lies  in  the  pelvis  behind  the  pubes  ;  in  the  male  in 
front  of  the  rectum  ;  in  the  female  it  is  placed  in  front  of  the 
uterus  and  vagina. 

Differences  in  the  sexes :  the  female  bladder  is  larger  trans- 
versely. 

The  apex  is  connected  to  the  umbilicus  by  the  urachus  and 
by  the  obliterated  hypogastric  arteries,  the  part  posterior  to 
the  urachus  being  covered  with  peritoneum. 

The  body  is  uncovered  anteriorly  by  peritoneum,  and  in 
front  are  the  triangular  ligament,  the  symphysis  and  body 
of  the  pubis,  and  pubo-prostatic  ligaments.  Superiorly  it 
is  covered  by  peritoneum  in  the  upper  part,  and  is  in 
relation  with  the  pelvic  colon  in  the  male,  and  uterus  in 
the  female,  and  with  small  intestines  in  both.  Crossing 


THE  URINARY  ORGANS 


219 


obliquely  on  each  side  of  the  bladder  is  the  obliterated 
hypogastric  artery,  which  marks  the  lateral  limit  of  its  peri- 
toneal covering ;  the  vas  deferens  crosses  obliquely  the  lower 
part  of  the  lateral  surface  along  the  inner  side  of  the  ureter 
and  obliterated  hypogastric  artery. 

The  base  or  fundus  is  directed  backwards  and  downwards. 


In  the 


Rectum,  from 
which  it  is 
separated  by 


Relations  of  the  Base. 

Male. 

Above. 

Recto  -  vesical 
pouch  of  peri- 
toneum. 

Below. 
Recto-vesical 

fascia. 
Vasadeferentia  and 

vesiculae   semin- 
,     ales. 


In  the  Female. 
Pouch  of  Douglas 
Cervix    uteri    and 

anterior  vaginal 

wall. 


The  cervix  or  neck  of  the  bladder  is  the  part  continuous 
with  the  urethra,  and  is  embraced  in  the  male  by  the  prostate. 

LIGAMENTS. — There  are  two  sets  of  ligaments  of  the 
bladder — true  and  false. 

The  true  ligaments  are  two  anterior  and  two  posterior. 
These  are  formed  of  recto-vesical  fascia,  and  are  described 
on  p.  48.  The  urachus  is  usually  described  as  the  5th  or 
superior  true  ligament. 

The  false  ligaments,  five  in  number,  are  formed  of  peri- 
toneum ;  there  are  two  posterior,  two  lateral,  and  an  anterior, 
the  latter  covering  the  urachus.  They  have  been  described 
on  p.  200. 

Interior  of  the  Bladder. — Upon  the  inner  surface  of  the  base 
of  the  bladder,  just  behind  the  urethral  orifice,  is  a  triangular 
smooth  surface  or  trigone,  with  the  apex  looking  forwards. 
It  is  bounded  laterally  by  two  ridges  passing  to.  the  openings 
of  the  ureters,  the  posterior  angles  being  formed  by  those 
openings,  placed  i£  inches  apart;  at  its  apex  there  is  an 
eJevation,  formed  by  the  prostate,  called  the  uvula  vesicce, 
which  is  i^  inches  from  the  ureters.  The  mucous  membrane 
over  the  trigone  is  smooth,  but  everywhere  else  elevated  upon 
the  irregular  muscular  wall  and  is  rugose. 


220  THE  POCKET  ANATOMY 

THE  MALE  ORGANS  OF  GENERATION. 

THE    PROSTATE   GLAND. 

The  prostate  gland  adjoins  the  neck  of  the  bladder  and 
surrounds  the  beginning  of  the  urethra,  which  is  placed 
nearer  the  anterior  than  the  posterior  surface  of  the  gland. 
It  is  said  to  resemble  a  horse-chestnut  in  shape,  with  the 
apex  directed  downwards.  It  measures  about  i^  inches 
across  its  base  and  i^  inches  in  depth,  and  i  inch  from 
before  backwards,  and  is  held  in  position  by  the  anterior 
true  ligaments  of  the  bladder. 

The  prostate  is  perforated  from  base  to  apex  by  the  urethra, 
into  which,  as  it  lies  in  the  gland,  the  common  ejaeulatory 
ducts  open. 

Relations : — 


Anterior  or  Pubic       Posterior 


Base.  Apex. 


Surface.  Surface. 

Symphysis  pubis.  Rectum.  Surrounds  bladder-     Rests      on      uppei 

Anterior  ligaments        ..     .       ..  neck.  layer    of     tnan- 

of  bladder.                  Laterally^  Vesiculae        semin-         gular  ligament. 

Dorsal       vein       of  Levator  ani.  ales. 


pens. 


Vasa  deferentia. 


The  prostate  is  surrounded  by  a  sheath  derived  from  the 
recto-vesical  fascia  (vide  p.  48)  and  by  the  prostatic  plexus  of 
veins,  and  is  supported  by  the  levator  ani. 

COWPER'S  GLANDS. 

Cowper's  glands  are  two  small  round  bodies  about  the  size 
of  a  pea,  placed  behind  the  membranous  part  of  the  urethra, 
between  the  two  layers  of  the  triangular  ligament.  Their 
ducts  are  about  I  inch  long,  and  pass  forwards,  piercing 
anterior  layer  of  triangular  ligament,  to  open  in  the  bulbous 
part  of  the  urethra. 

THE    PENIS. 

The  penis  is  divided  into  a  root,  body,  and  glans. 

The  root  is  connected  to  the  pubic  rami  by  two  strong  pro- 
cesses, the  crura,  and  to  the  symphysis  pubis  by  the  sus- 
pensory ligament. 

The  glans  forms  the  extremity  ;  at  its  summit  is  the  opening 


MALE  ORGANS  OF  GENERATION  221 

of  the  urethra,  the  meatus  urinarius;  passing  from  the  lower 
margin  of  this  is  a  fold  of  mucous  membrane  continuous  with 
the  prepuce  and  called  the  frenum  prtzputii.  At  the  base  of 
the  glans  is  a  projecting  edge  or  corona,  and  behind  that  a 
constriction,  the  cervix.  Sebaceous  glands  (of  Tyson)  are 
found  on  both.  The  integument  of  the  penis,  attached  to 
the  neck  of  the  glans,  is  doubled  upon  itself,  forming  the 
prepuce  or  foreskin. 

The  body  is  the  part  between  the  root  and  the  glans,  the 
upper  surface  being  the  dor  sum. 

The  corpora  cavernosa  form  the  greater  part  of  the  body 
of  the  penis;  they  are  two  cylindrical  columns  placed  side 
by  side,  connected  together  for  the  anterior  f  ths,  the  septum 
pectiniforme  intervening,  but  separated  behind  to  form  the 
two  crura,  which  are  attached  to  the  inner  margins  of  the 
ischial  and  pubic  rami  ;  anteriorly  the  corpora  cavernosa  fit 
into  the  base  of  the  glans.  There  is  a  groove  on  the  upper 
surface  for  the  dorsal  vein  of  the  penis  and  another  groove 
on  the  lower  surface  for  the  corpus  spongiosum  ;  the  corpora 
are  attached  to  the  pubic  symphysis  by  the  suspensory  liga- 
ment. 

The  corpus  spongiosum  commences  at  the  triangular  liga- 
ment by  an  enlargement,  the  bulb,  and  runs  forward  in  the 
groove  on  the  under  surface  of  the  corpora  cavernosa,  ex- 
panding over  their  extremities  to  form  the  glans.  The  bulb 
lies  below  the  anterior  or  lower  layer  of  the  triangular 
ligament,  and  is  embraced  by  the  accelerator  urinae  muscle. 
The  urethra  pierces  the  bulb  near  its  upper  surface,  and  then 
runs  forward  in  the  middle  of  the  corpus  spongiosum. 

The  URETHRA  in  the  male  extends  from  the  neck  of  the 
bladder  to  the  end  of  the  penis,  and  has  a  length  of  from  6  to 
8  inches.  It  is  divided  into  three  parts,  according  to  the 
structures  through  which  it  passes. 

(1)  The  prostatic  portion  passes  through  the  prostate  gland 
from  base  to  apex  ;  this  part  is  ij  inches  long  and  spindle- 
shaped  :    in   cross-section  it  is  horseshoe-shaped,   with   the 
convexity  forwards.     On  the  posterior  wall  is  a  longitudinal 
ridge,  the  verumontanum  or  caput  gallinaginis,  and  on  each  side 
of  this  promontory  is  a  depression,  the  prostatic  sinus,  into 
which  the  prostatic  ducts  open.     Towards  the  anterior  part 
of  the  verumontanum   is   a  depression,   the  sinus  pocularis, 
vesicula  prostatica,  or  utricle,  upon  the  elevated  edges  of  which 
the  ejaculatory  ducts  open. 

(2)  The  membranous  portion  extends  from  the  apex  of  the 
prostate  to  the  bulb,  and  is  £  inch  long  anteriorly,  but  only 


222  THE  POCKET  ANATOMY 

£  inch  posteriorly  from  the  bulb  projecting  backwards; 
it  is  contained  between  the  layers  of  the  triangular  ligament, 
and  is  surrounded  by  the  compressor  urethrae. 

(3)  The  spongy  portion  is  contained  in  the  corpus  spongiosum 
and  occupies  the  rest  of  the  canal,  being  from  4  to  6  inches 
long  ;  the  portion  contained  in  the  bulb  is  somewhat  dilated, 
and  the  ducts  of  Cowper's  glands  open  on  the  floor  ;  the  canal 
enlarges  again  iust  behind  the  meatus  urinarius,  which  enlarge- 
ment is  named  the  fossa  navicularis.  The  lumen  of  this  part 
of  the  urethra  is  transverse,  except  at  the  meatus  (its  narrowest 
part),  where  it  is  vertical. 

The  floor  of  the  urethra  is  sprinkled  with  lacuna,  which  are 
the  openings  of  the  glands  of  Littre ;  one  large  one  in  the  fossa 
navicularis  is  called  the  lacuna  magna. 

THE   SCROTUM. 

The  scrotum  contains  the  testicles  and  spermatic  cords.  It 
is  divided  in  the  middle  line  by  a  raphe ;  the  left  half  is  longer 
than  the  right,  as  the  left  testicle  hangs  down  lower,  the  left 
spermatic  cord  being  longer  than  its  fellow. 

Coverings  of  the  Testis  in  the  Scrotum  : — 

1.  Skin. 

2.  Superficial  fascia  and  dartos  muscle. 

3.  Inter-columnar  or  spermatic  fascia. 

4.  Cremaster  muscle  and  fascia. 

5.  Infundibuliform  fascia,  continuous  with  the  transversalis 
fascia. 

6.  Tunica  vaginalis,  consisting  of  a  parietal  and  visceral 
layer,  forms  a  closed  sac.     The  visceral  layer  invests  the 
body  and  epididymis  of  the  testicle  except  behind,  where  the 
duct  and  vessels  are  attached ;  at  its  lateral  reflection  it  is 
continuous  with  the  parietal  layer.   It  passes,  on  the  outer  side, 
a  little  between  epididymis  and  body,  forming  the  digital  fossa. 

THE    SPERMATIC   CORD. 

The  spermatic  cord  consists  of  the  vas  deferens  with  artery 
to  the  vas,  spermatic  artery  and  pampiniform  plexus  of  veins 
forming  spermatic  vein  above,  sympathetic  nerves,  the 
cremasteric  artery,  the  genital  branch  of  the  genito-crural 
nerve,  lymphatics,  together  with  some  areolar  tissue;  it 
extends  from  the  internal  abdominal  ring  to  the  testis,  passing 
in  its  course  along  the  inguinal  canal,  from  which  it  emerges 
by  the  external  abdominal  ring,  and  thence  in  front  of  the 


MALE  ORGANS  OF  GENERATION 


223 


pubes  to  the  scrotum.     The  vas  deferens  is  placed  at  the  back 

of  the  cord,  and  may  be  recognised  by  its  hard  and  cord-like 

feeling. 

Boundaries  of  the  Inguinal  or  Spermatic  Canal : — 

Extent :  i£  inches  long,  from  the  internal  to  the  external 

abdominal  ring 


Behind. 

Peritoneum  and 
fascia  trans- 
versalis  for 
whole  length. 

Conjoined  ten- 
don  (inner 
two-thirds). 

Triangular 
fascia. 


In  Front.  Floor  formed  by 

Internal    oblique     Meeting  of  Pou- 


(outer  third). 
Aponeurosis  of 
external  ob- 
lique  (for  whole 
length). 


part's  liga- 
ment  and 
fascia  trans- 
versalis. 


Rooffonned  by 
Arched  fibres  of 
internal  oblique 
and  trans  versalis, 
and  apposition  of 
layers  of  abdo- 
minal wall. 


THE    TESTES. 


The  testes  are  two  glandular  organs  ;  each  is  suspended  in 
the  scrotum  by  the  spermatic  cord,  which  is  attached  to  the 
posterior  border.  Each  testis  consists  of  two  parts :  the  body, 
which  is  anterior,  and  the  epididymis,  placed  posteriorly;  to 
the  lower  end  of  this  latter  the  duct  or  vas  deferens  is  attached. 

Coverings  of  the  Testis  : — 

1.  Serous  or  tunica  vaginalis  is  derived  from  the  peritoneum, 
and  consists  of  two  layers,  the  visceral  and  parietal. 

2.  Fibrous  or  tunica  albuginea  covers  the  body  of  the  testicle, 
sending  in  a  vertical  septum  the  mediastinum  or  corpus  High- 
ntori  :  this  latter  gives  off  secondary  processes  or  septa,  which 
serve  to  separate  the  lobules  of  the  testicle. 

3.  Tunica  vasculosa  consists  of  the  bloodvessels,  connected 
together  with  areolar  tissue. 

The  epididymis  is  a  long  narrow  body,  consisting  of  three 
parts,  viz. :  a  superior  portion  projecting  forwards  on  the 
upper  end  of  the  body,  the  head  or  globus  major ;  a  lower,  the 
tail  or  globus  minor,  with  which  the  vas  deferens  is  continuous ; 
and  between  these  two,  the  body  or  central  portion.  The 
epididymis  consists  of  a  duct  20  feet  long,  exceedingly  con- 
voluted, and  bound  together  by  areolar  tissue  ;  it  receives  the 
coni  vasculosi  at  the  upper  part  of  the  testicle. 

The  body  of  the  testicle  consists  of  numerous  lobules  of 
pyramidal  shape,  which  are  formed  by  trabeculae,  mediastinum, 
and  tunica  albuginea,  the  base  of  the  lobule  being  directed 
10  the  circumference  of  the  testis,  and  the  apex  towards  the 
mediastinum.  Each  lobule  contains  one  or  more  tubuli  semini- 
/eri  held  together  by  areolar  tissue.  Each  tubule  commences 


224  THE  POCKET  ANATOMY 

near  the  base,  in  either  a  blind  extremity  or  by  anastomotic 
loops,  becoming  straighter  near  the  apex  ;  as  they  enter  the 
mediastinum,  they  coalesce  together  to  form  twenty  or  thirty 
tubuli  recti. 

The  tubuli  recti  or  vasa  recta  pierce  the  mediastinum,  inter- 
lace, and  form  the  vete  testis. 

Above  twelve  to  twenty  tubules  pass  from  the  upper  part  of 
the  rete  as  the  vasa  efferentia. 

The  vasa  efferentia  perforate  tunica  albuginea,  being  at  first 
straight,  then  convoluted,  and  as  the  coni  vasculosi  form  the 
globus  major. 

The  coni  open  into  the  excretory  duct  at  intervals  (when 
unravelled)  of  about  3  inches. 

The  vas  deferens  commences  at  the  lower  part  of  the  globus 
minor,  and  ascends  along  the  inner  side  of  the  posterior  part 
of  the  epididymis ;  thence  it  follows  the  spermatic  cord  through 
the  inguinal  canal  and  internal  abdominal  ring.  Here  it  lies 
under  the  peritoneum  and  passes  inwards,  crossing  to  the 
inner  side  of  the  external  iliac  artery,  and,  entering  the  pelvis, 
arches  over  the  superior  surface  of  the  bladder,  crossing  the 
obliterated  hypogastric  artery  and  ureter.  At  the  base  of  the 
bladder  it  runs  along  the  inner  side  of  the  vesiculas  seminales 
and  loses  its  peritoneal  covering,  being  separated  from  the 
rectum  by  the  recto-vesical  fascia,  here  becoming  sacculated  ; 
narrowing  again  at  the  base  of  the  prostate,  it  unites  with 
the  duct  of  the  vesicula  seminalis  of  the  same  side,  and  forms 
the  common  ejaculatoiy  duct,  which  passes  forwards  through 
the  prostate  and  opens  on  the  lateral  margin  of  the  sinus 
pocularis  into  the  prostatic  urethra. 

THE    VESICULA    SEMINALES. 

The  vesiculse  seminales  are  two  sacculated  pouches,  placed 
between  the  base  of  the  bladder  in  front  and  the  rectum 
behind.  They  are  pyramidal  in  shape,  the  posterior  part 
being  the  wider ;  anteriorly  they  converge  to  enter  the 
prostate  near  the  middle  line.  The  corresponding  vas  deierens 
lies  on  the  inner  side. 


THE  FEMALE  ORGANS  OF  GENERATION. 

The  external  organs  of  generation  in  the  female  are :  the 
mons  veneris,  the  labia  majora,  the  labia  minora,  the  clitoris, 
the  meatus  urinarius,  and  the  orifice  of  the  vagina.  The  term 
vulva  includes  the  whole  of  these. 


FEMALE  ORGANS  OF  GENERATION  225 

The  mons  veneris  is  the  eminence  in  front  of  the  pubes, 

covered  with  hair. 

The  labia  majora  are  two  prominent  folds  extending  from 
the  mons  to  the  perineum.  Externally  they  are  covered  with 
hair  and  integument,  internally  with  mucous  membrane;  the 
labia  are  joined  together  anteriorly  and  posteriorly,  forming 
commissures.  A  small  transverse  fold  of  mucous  membrane 
is  found  in  the  posterior  commissure  called  the  fourchette ;  the 
space  between  this  and  the  posterior  commissure  is  known  as 
the  fossa  navicularis . 

The  labia  minora  or  nymphse  are  two  folds  of  mucous 
membrane,  extending  for  i\  inches  downwards  and  outwards 
from  the  clitoris,  finally  losing  themselves  below  in  the  labia 
majora.  They  surround  the  clitoris,  the  upper  folds  forming 
the  preputium  clitoridis,  the  lower  ones,  attached  o  the  glands, 
being  the  fmnum. 

The  clitoris,  corresponding  somewhat  in  structure  to'  the 
penis,  is  placed  just  below  the  anterior  commissure.  It  con- 
sists of  two  corpora  cavernosa  attached  to  the  pubic  rami  by 
two  crura ;  the  free  extremity  or  glans  is  formed  by  the  corpus 
spongiosum.  Between  the  nymphae,  and  bounded  anteriorly 
by  the  clitoris,  is  the  vestibule,  at  the  back  part  of  which  the 
meatus  urinanus  opens,  being  about  i  inch  below  the  clitoris. 

The  Bulb  of  the  Vestibule. — A  mass  of  erectile  tissue  lying 
internal  to  the  nymphas,  and  resting  on  the  inferior  surface  of 
the  triangular  ligament. 

Below  the  meatus  is  the  orifice  of  the  vagina,  closed  more 
or  less  in  the  virgin  by  the  hymen,  which  is  a  duplicature  of 
mucous  membrane,  generally  semilunar  in  shape.  After  its 
rupture  small  elevations,  carunculcs  myrtiformes,  only  remain. 

The  glands  of  Bartholin,  analogous  to  Cowper's  glands  in 
the  male,  are  situated  on  each  side  near  the  entrance  of  the 
vagina,  and  their  ducts  open  on  the  nymphae,  external  to  the 
hymen. 

The  urethra  in  the  female  is  only  i£  inches  long,  and  is 
embedded  in  the  anterior  wall  of  the  vagina ;  it  perforates  the 
triangular  ligament,  as  in  the  mala.  The  meatus  urinarius,  the 
external  orifice  of  the  urethra,  opens  between  the  nymphae, 
about  an  inch  below  and  behind  the  clitoris. 

The  vagina  is  a  dilatable  canal,  the  axis  of  which  is  naturally 
transverse,  extending  from  the  vulva  to  the  uterus ;  the  an- 
terior wall  is  about  3^  inches  and  the  posterior  wall  4^  inches 
long.  The  upper  end  widens  to  receive  the  neck  of  the 
uterus,  which  it  meeis  at  an  anglu  anteriorly  of  about 
90  degrees. 

15 


226  THE  POCKET  ANATOMY 

The  relations  are  : — 

Anteriorly.                  Posteriorly.  Laterally. 

Base  of  bladder.        Perineal  body.  Broad  ligament  and 

Urethra.                     Rectum  and  anal  ureter. 

canal.  Levator  ani, 

Pouch  of  Douglas  Sphincter  vaginse. 
(upper  inch). 

There  is  a  ridge  or  raphe  along  the  middle  of  the  inner 
surface  of  both  the  anterior  and  posterior  walls.  The  walls 
likewise  present  many  transverse  ridges  or  ruga.  The  lower 
end  of  the  vagina  is  embraced  by  the  sphincter  vaginae. 

THE    UTERUS. 

The  uterus  or  womb  is  a  pear-shaped  body,  flattened  from 
before  backwards,  placed  in  the  pelvis  between  the  bladder 
and  rectum ;  superiorly  it  does  not  reach  above  the  brim  of 
the  pelvis.  The  position  corresponds  to  the  pelvic  axis.  The 
uterus  is  covered  by  peritoneum  behind,  above,  and  in  front 
except  where  it  is  attached  to  the  base  of  the  bladder ;  the 
peritoneum  is  reflected  from  off  the  sides  to  the  pelvis,  forming 
the  broad  ligaments.  The  average  length  of  the  uterus  is  3  inches, 
breadth  2  inches,  and  thickness  i  inch,  and  it  is,  for  the  pur- 
pose of  description,  divided  into  three  parts  : — 

(1)  The  fundus  is  the  broad  upper  end  of  the  body,  projecting 
into  the  abdomen  between  the  attachments  of  the  Fallopian 
tubes. 

(2)  The  body  extends  from  the  fundus  to  the  neck,  narrowing 
as  it  approaches  the  latter ;  at  the  junction  of  the  fundus  and 
body  is  an  angle  to  which  the  Fallopian  tube  is  attached ;  a 
little  anteriorly  to  this  the  round  ligament  is  connected,  below 
and  behind  this  the  ovarian  ligament  is  attached. 

(3)  The  neck  or  cervix  uteri  is  surrounded  below  by  the 
vagina,  into  which  it  projects,  forming  a  vaginal  part,  which 
presents  a  transverse  opening,  the  os  uteri  externum,  bounded 
by  two  thick  lips,  anterior  and  posterior,  of  which  the  anterior 
is  the  thicker  and  the  posterior  the  longer.     The  part  pro- 
jecting into  the  vagina  is  called  the  portio  vaginalis.     The 
sulci  in  front  of  the  anterior  and  behind  the  posterior  lips  are 
the  anterior  and  posterior  fornices,   of  which  the  posterior  is 
much   the   deeper,    and   behind    is   in   direct   relation   with 
peritoneum  (pouch  of  Douglas). 

The  cavity  of  the  uterus,  flattened  from  before  backwards, 
is  triangular  in  shape,  the  superior  angles  leading  to  tht. 


FEMALE  ORGANS  OF  GENERATION          227 

Fallopian  tubes.  Where  the  body  joins  the  neck  there  is  a 
constriction,  the  os  uteri  internum. 

The  ligaments  are  two  anterior  or  utero-vesical,  two  pos- 
terior or  recto- vaginal,  and  two  lateral  or  broad  ligaments,  all 
formed  of  peritoneum. 

The  broad  ligaments  are  formed  of  a  double  layer  of  peri- 
toneum passing  from  the  lateral  margins  of  the  uterus  to  the 
sides  of  the  pelvis.  Between  the  two  layers  of  this  ligament 
on  each  side  are  the  Fallopian  tube,  the  round  ligament,  the 
parovarium,  the  ovary  and  its  ligament,  uterine  and  ovarian 
vessels,  nerves  and  lymphatics. 

The  round  ligament  is  a  cord  placed  between  the  layers  of 
the  broad  ligament,  extending  from  the  superior  angle  of  the 
uterus  to  the  internal  abdominal  ring ;  thence  it  passes  into 
the  inguinal  canal  to  lose  itself  in  the  labium.  It  is  enclosed 
for  some  part  of  the  way  in  peritoneum,  which  is  known  as 
the  canal  of  Nuck. 

THE    APPENDAGES   OF   THE   UTERUS. 

The  Fallopian  tubes  are  two  in  number,  placed  in  the 
upper  margin  of  the  broad  ligament.  Each  tube  measures 
about  4  inches  in  length.  The  cavity  commences  by  a  narrow 
orifice  called  the  ostium  internum,  and  terminates  in  a  fimbriated 
extremity,  which  passes  over  the  superior  and  posterior  borders 
of  the  ovary,  and  is  attached  by  the  fimbria  ovarica  to  the 
superior  pole  of  the  ovary. 

The  ovaries  are  two  in  number,  and  correspond  to  the  testes 
in  the  male ;  they  are  of  a  flattened  ovoid  form,  vertically 
placed  in  the  posterior  part  of  the  broad  ligament.  By  its 
anterior  border  the  ovary  is  connected  to  the  broad  ligament, 
and  by  its  lower  pole  to  the  uterus  by  a  proper  ligament, 
extending  to  the  superior  angle  of  the  uterus,  and  called  the 
ligament  of  the  ovary.  The  lateral  surfaces  and  posterior 
border  are  free.  The  superior  pole  and  posterior  border  are 
embraced  by  the  Fallopian  tube ;  on  its  inner  surface  it  is  in 
relation  with  small  intestine  in  Douglas'  pouch,  and  exter- 
nally lies  in  a  peritoneal  fossa  between  the  external  and  internal 
iliac  vessels  as  they  diverge.  The  vessels  enter  the  hilum  at 
the  attached  anterior  border. 

The  parovarium  lies  between  the  Fallopian  tube  and  ovary, 
and  is  the  remains  of  the  Wolffian  body. 


15-* 


228  THE  POCKET  ANATOMY 


THE  NOSE. 

The  organ  of  smell  consists  of  an  anterior  prominent  part, 
situated  on  the  face,  and  composed  of  bones,  cartilages, 
muscles,  and  integument,  and  two  nasal  fosses. 

The  cartilages  of  the  nose  are  five  in  number : — 

The  upper  lateral  cartilages  (2)  :  situated  just  below  the  free 
margins  of  the  nasal  bones.  Each  cartilage  is  triangular  in 
shape ;  anteriorly  it  joins  its  fellow  and  the  cartilage  of  the 
septum  ;  posteriorly  it  is  in  connection  with  the  nasal  process 
of  the  superior  maxilla,  and  inferiorly  it  joins  the  lower  lateral 
cartilage. 

The  lower  lateral  cartilages  (2)  are  peculiarly  curved  to  form 
the  nostrils,  laterally  and  mesially,  being  open  behind; 
laterally  each  cartilage  is  connected  to  the  nasal  process  of 
the  superior  maxilla  by  fibrous  membrane,  in  which  are  two 
or  three  sesamoid  cartilages ;  above  it  joins  the  upper  cartilage 
and  the  cartilage  of  the  septum. 

The  cartilage  of  the  septum  is  thicker  at  the  edges  than  at  the 
centre  ;  its  connections  are  :  anteriorly,  with  the  nasal  bones, 
the  two  upper  lateral  cartilages  and  the  lower  lateral  carti- 
lages ;  posteriorly,  with  the  perpendicular  plate  of  the  ethmoid ; 
inferiorly,  with  the  vomer  and  the  palatal  processes  of  the 
superior  maxillae. 

The  nasal  fossae,  separated  from  each  other  by  the  septum 
nasi,  open  in  front  by  the  anterior  nares  and  behind  by  the 
posterior  nares.  Each  fossa  may  be  described  as  possessing 
a  roof,  a  floor,  an  inner  and  an  outer  wall. 

The  roof  is  formed  by  the  nasal  bones,  the  nasal  spine  of 
the  frontal,  the  cribriform  plate  of  the  ethmoid,  the  under 
surface  of  the  body  of  the  sphenoid,  alae  of  the  vomer, 
sphenoidal  processes  of  the  palate  bones. 

The  floor  consists  of  the  palatal  processes  of  the  superior 
maxillae  and  of  the  palate  bones. 

The  inner  wall  is  made  up  of  the  cartilage  of  the  septum,  the 
crest  of  the  nasal  bones,  the  nasal  spine  of  the  frontal,  the 
perpendicular  plate  of  the  ethmoid,  the  vomer,  the  rostrum 
of  the  sphenoid,  and  the  crests  of  the  superior  maxillary  and 
palate  bones. 

The  outer  wall  is  formed  by  the  nasal  process  of  the  superior 
maxilla,  the  lachrymal  bone,  the  ethmoid,  inner  surface  of 
the  superior  maxilla,  the  inferior  turbinate  bone,  the  vertical 
plate  of  the  palate  bone,  and  the  internal  pterygoid  plate  of 
the  sphenoid. 

Meatuso*  — The  superior  and  middle  turbinate  processes  of 


THE  NOSE  229 

the  ethmoid  and  the  inferior  turbinate  bone  project  inwards 
from  the  outer  wall,  dividing  each  fossa  into  a  superior,  a 
middle,  and  an  inferior  meatus. 

Openings : — 

Superior  meatus  :  sphenoidal  and  posterior  ethmoidal  cells. 

Middle  meatus :  anterior  ethmoidal  cells  and  frontal  sinus, 
by  a  common  orifice  the  infundibulum,  and  antrum  of  High- 
more. 

Inferior  meatus  :  nasal  duct. 

The  septum  is  the  partition  separating  the  two  fossae.  It  is 
formed  by  the  perpendicular  plate  of  the  ethmoid,  the  vomer, 
crest  of  nasal  bones,  the  nasal  spine  of  the  frontal,  the  rostrum 
of  the  sphenoid,  the  crests  of  the  superior  maxillary  and  palate 
bones,  and  the  cartilage  of  the  septum.  The  space  between 
the  anterior  nares  and  the  anterior  edge  of  the  cartilage  of  the 
septum  is  filled  by  membrane,  the  columna  nasi. 

The  anterior  nares  are  the  anterior  openings  of  the  nasal 
fossae.  They  are  separated  from  each  other  by  the  columna 
nasi,  and  within  the  margin  are  arranged  short  stiff  hairs, 
vibrissa. 

The  posterior  nares  open  backwards  into  the  pharynx. 
They  are  oval  in  shape,  being  about  I  inch  vertically  and 
£  inch  transversely. 

Sinuses. — The  nasal  fossae  communicate  with  the  following 
sinuses  in  the  neighbouring  bones,  the  mucous  membrane 
of  the  nose  being  continued  into  them  : — 

r.  Sphenoidal  sinus. 

2.  Posterior  ethmoidal  cells. 

3.  Anterior  ethmoidal  cells. 

4.  Frontal  sinus. 

5.  Maxillary  antrum. 

The  mucous  membrane  lining  the  cavity  of  the  nose  is  called 
the  Schneiderian  membrane.  It  is  continuous  with  that  of 
the  various  sinuses  communicating  with  the  nasal  fossae,  with 
the  conjunctiva  through  the  nasal  duct  and  lachrymal 
canals,  with  the  mucous  membrane  of  the  pharynx  through 
the  posterior  nares,  and  with  the  skin  of  the  face  through 
the  anterior  nares.  On  the  outer  wall,  as  on  the  septum,  the 
mucous  membrane  is  inappreciably  divided  into  an  upper, 
olfactory,  and  a  lower,  respiratory,  part ;  the  olfactory  part 
consists  of  the  mucosa  over  the  superior  and  upper  part  of 
the  middle  turbinated,  the  corresponding  part  of  the  septum 
and  the  roof  of  the  nose  ;  the  remainder  being  respiratory. 

The  epithelium  covering  the  surface  consists  of  three 
varieties : — 


2 jo  THE  POCKET  ANATOMY 

1.  Stratified  squamous,  in  the  region  of  the  nostrils. 

2.  Columnar,  in  the  olfactory  region. 

3.  Ciliated  columnar,   in   the    respiratory   region    and    the 
sinuses. 

The  vessels  to  the  nose  are  the  following  arteries  and  veins  : 
spheno-palatine,  branches  of  descending  palatine,  and  arteria 
septi  nasi  from  facial.  The  nerves  are  :  olfactory,  nasal  (first 
division  5th),  naso-palatine,  nasal  branch  of  Vidian,  nasal 
branch  from  anterior  palatine  and  from  Meckel's  ganglion. 

The  Olfactory  Nerve. — From  the  olfactory  lobe  there  pro- 
ceed about  twenty  branches  through  the  cribriform  plate  of 
the  ethmoid,  which  may  be  divided  into  three  sets : — 

1.  Inner :  pass  along  the  grooves  on  the  septum. 

2.  Middle  :  distributed  to  the  roof. 

3.  Outer:  passing  to  the  upper  turbinate  bone,  the  anterior 
part  of  plain  surface  of  the  ethmoid  and  the  middle  turbinate 
bones. 

THE  EAR. 

The  ear  is  divided,  for  the  purpose  of  description,  into 
three  parts,  external,  middle,  and  internal. 

THE    EXTERNAL   EAR. 

The  external  er>r  consists  of  the  auricle  or  pinna,  and  the 
external  auditory  meat  us. 

The  pinna  is  a  plate  of  cartilage  covered  with  integument, 
and  attached  to  the  commencement  of  the  meatus ;  it  has 
numerous  ridges  and  depressions,  as  follows :  the  external 
rim  is  the  helix,  and  anterior  and  parallel  to  it  is  another 
ridge,  the  anti  helix,  which  bifurcates  above  to  enclose  the 
fossa  of  the  anti-helix ;  between  the  helix  and  anti-helix  is  the 
fossa  of  the  helix .  Anterior  to  the  anti-helix  is  a  depression, 
the  concha;  projecting  backwards  over  the  meatus  is  the 
tragus,  and  opposite  to  the  latter  is  the  anti-tragus.  The 
lowest  part  of  the  pinna,  which  contains  no  cartilage,  is  called 
the  lobule.  It  is  controlled  by  three  muscles  (p.  22). 

The  external  auditory  meatus  reaches  from  the  bottom  of 
the  concha  to  the  membrana  tympani ;  it  is  i£  inches  long. 
It  is  arched  slightly  upwards,  and  is  directed  forwards  and 
inwards ;  it  is  formed  partly  by  cartilage  and  partly  by  bone. 
The  outer  or  cartilaginous  part  is  continuous  with  the  pinna, 
and  is  about  £  inch  long.  The  cartilage  does  not  form  a 


THE  EAR 


231 


complete  tube,  being  deficient  at  the  upper  and  back  part, 
the  interval  being  filled  by  fibrous  tissue.  One  or  two 
fissures  (fissures  of  Santorini)  partially  traverse  the  tube. 
The  inner  or  osseous  part  is  longer  than  the  preceding,  and 
at  its  inner  end  there  is  a  groove  round  the  sides  and  floor  for 
the  insertion  of  the  membrana  tympani.  In  the  cartilaginous 
part  of  the  meatus  are  hairs  and  ceruminous  glands,  which 
latter  secrete  the  ear-wax. 


THE    MIDDLE    EAR   OR   TYMPANUM. 

The  tympanum  is  contained  in  the  temporal  bone.  It  com- 
municates with  the  pharynx  by  the  Eustachian  tube,  and  is 
traversed  by  a  chain  of  bones,  which  connect  the  membrana 
tympani  with  the  internal  ear. 

The  cavity  of  the  tympanum  is  bounded  externally  by  the 
meatus  and  membrana  tympani,  internally  by  the  external 
surface  of  the  internal  ear,  and  it  communicates  posteriorly 
with  the  mastoid  antrum. 

Thereof  (tegmen  tympani)  is  formed  by  a  thin  plate  of  bone 
separating  the  tympanum  from  the  middle  fossa  of  the  skull. 

The  floor  is  formed  by  the  roof  of  the  jugular  fossa. 

The  outer  wall  is  formed  by  the  membrana  tympani  and 
the  bone  around  it ;  the  following  fissures  are  seen  : — 

The  Glaserian  fissure  :  through  which  the  processus  gracilis 
of  the  malleus  and  tympanic  branch  of  internal  maxillary 
artery  pass. 

Aperture  of  the  iter  chorda  posterius  :  leading  to  a  canal 
which  opens  into  the  aquseductus  Fallopii. 

Aperture  of  the  iter  chorda  anterius  :  leading  to  the  canal  of 
Huguier,  and  transmitting  the  chorda  tympani. 

The  inner  wall  presents  the  following  : — 

The  fenestra  ovalis :  leading  into  the  vestibule,  closed  by  a 
membrane  and  the  base  of  the  stapes. 

The  ridge  of  the  aquaductus  Fallopii :  for  the  facial  nerve 
placed  just  above  the  preceding ;  posteriorly  it  passes  down- 
wards and  backwards  on  the  mesial  aspect  of  the  large  opening 
of  the  aditus  ad  an£nim. 

The  promontory :  placed  below  the  fenestra  ovalis,  formed 
by  the  projection  of  the  first  turn  of  the  cochlea. 

The  fenestra  rotunda  lies  at  the  bottom  of  a  funnel-shaped 
depression  behind  the  promontory.  It  is  closed  by  a  mem- 
brane, the  secondary  membrane  of  the  tympanum  of  Scarp  a,  which 
closes  an  aperture  in  the  bone  leading  to  the  scala  tympani 
of  the  cochlea. 


232  THE  POCKET  ANATOMY 

The  posterior  wall  presents  above  the  large  aperture  of  the 
mastoid  antrum  (aditus  ad  antrum}  and  below : 

The  pyramid  which  is  placed  just  behind  the  fenestra  ovalis ; 
it  contains  the  stapedius,  the  tendon  of  which  projects  through 
the  apex. 

The  anterior  wall  shows  the  following : — 

The  canal  for  the  tensor  tympani,  opening  just  anteriorly  to 
the  fenestra  ovalis. 

The  processus  cochleariformis :  a  process  of  bone  lying  be- 
tween and  separating  the  canal  for  the  tensor  tympani  and 
the  Eustachian  tube. 

The  Eustachian  tube  leads  into  the  pharynx,  is  partly  carti- 
laginous and  partly  osseous ;  the  internal  or  cartilaginous  part 
is  trumpet-shaped,  and  terminates  in  an  oval  opening  at  the 
side  and  upper  part  of  the  naso-pharynx.  The  osseous  portion 
is  placed  along  the  angle  of  union  of  the  squamous  and  petrous 
portions  of  the  temporal  bone,  and  is  about  £  inch  long. 
Below  this  a  thin  plate  of  bone  separates  the  tympanum 
from  the  carotid  canal. 

The  membrana  tympani  is  the  membrane  which  separates 
the  external  and  middle  ears.  It  is  inserted  into  the  groove 
in  the  osseous  portion  of  the  external  meatus,  and  is  placed 
obliquely  across  the  opening,  forming  with  the  floor  of  the 
meatus  an  angle  of  45°.  It  contains  the  handle  of  the  malleus 
between  its  layers,  which  makes  the  membrane  concave  ex- 
ternally. There  is  a  small  notch  in  the  upper  and  anterior 
part  of  the  groove  of  insertion  known  as  the  notch  of  Rivini, 
which  is  closed  by  a  loose  portion  of  the  membrane,  the 
membrana  ftaccida  of  Shrapnell. 

Structure  of  the  membrane,  from  without  inwards: — 

1.  Prolongation  of  skin  of  meatus. 

2.  Fibrous  tissue  or  membrana  propria. 

3.  Mucous  membrane  of  the  tympanum. 

The  ossicles  of  the  tympanum  are : — 

1.  The  Malleus. 

2.  The  Incus. 

3.  The  Stapes. 

The  malleus,  or  hammer,  consists  of : — 

The  head:  the  thickened  upper  part,  presenting  on  tne 
posterior  surface  a  facet  for  articulation  with  the  body  of  the 
i-icus. 

The  neck :  a  constriction  below  the  head. 


THE  EAR  233 

The  handle:  a  long  tapering  process  passing  downward, 
and  attached  by  its  outer  side  to  the  membrana  tympani. 

The  processus  gracilis :  a  slender  spicule  passing  from  the 
neck  downwards  and  forwards  into  the  Glaserian  fissure. 

The  processus  brevis :  arises  from  the  root  of  the  handle  and 
projects  outwards  to  be  attached  to  the  membrana  tympani 
by  the  anterior  and  posterior  malleal  folds  which  bound  the 
notch  of  Rivini. 

The  incus,  or  anvil,  consists  of : — 

The  body :  articulating  in  front  by  a  saddle-shaped  facet 
with  the  head  of  the  malleus. 

The  processus  brevis  :  attached  to  the  margin  of  the  mastoid 
aditus. 

The  processus  longus :  passes  downwards,  behind  and  parallel 
to  the  handle  of  the  malleus.  The  tip  projects  inwards, 
and  ends  in  the  orbicular  process,  which  articulates  with  the 
head  of  the  stapes. 

The  stapes  closely  resembles  a  stirrup.     It  consists  of: — 

The  head:  looking  outwards,  and  articulating  with  the 
orbicular  process  of  the  incus. 

The  base  :  fixed  to  the  margins  of  the  fenestra  ovalis. 

The  crura  :  arising  from  a  constricted  part,  the  neck,  pass 
inwards  to  the  extremities  of  the  base.  The  anterior  crus  is 
shorter  r-xd  straighter  than  the  posterior,  and  between  the 
two  a  th.n  membrane  is  stretched. 

The  ligaments  unite  the  chain  of  bones  to  the  adjacent 
walls  of  the  tympanum.  They  are : — 

The  anterior  ligament  of  the  malleus :  passing  between  the 
root  of  the  processus  gracilis  and  the  edge  of  the  Glaserian 
fissure.  This  ligament  was  formerly  described  as  a  muscle 
passing  from  the  malleus  out  of  the  Glaserian  fissure,  and 
termed  the  laxator  tympani. 

The  external  ligament  of  the  malleus :  passing  between  the 
processus  brevis  and  notch  of  Rivini. 

The  superior  ligament  of  the  malleus :  passing  between  the 
head  of  the  malleus  and  the  roof  of  the  tympanum. 

The  ligament  of  the  incus :  passing  between  the  processus 
brevis  and  the  posterior  wall  of  the  tympanum. 

The  annular  ligament  of  the  stapes  connects  the  base  of  the 
stapes  with  the  edge  of  the  fenestra  ovalis. 

The  muscles : — 

The  tensor  tympani  arises  from  cartilage  of  the  Eustachian 
tube,  and  from  the  bony  canal  in  which  it  lies.  The  tendon 
turns  round  the  end  of  the  processus  cochleariformis,  and 
is  inserted  into  the  inner  border  of  the  handle  of  the  malleus, 
near  its  root. 


234  THE  POCKET  ANATOMY 

The  stapedius  is  lodged  in  the  aquaeductus  Fallopii  and 
pyramid.  The  tendon  issues  from  the  apex  of  the  pyramid, 
and  is  inserted  in  the  posterior  part  of  the  neck  of  the  stapes. 

The  mastoid  antrum  is  a  large  recess  placed  behind  and 
rather  above  the  tympanum,  with  which  it  is  connected  by 
the  large  opening  (aditus)  before  mentioned  on  the  upper  part 
of  the  posterior  tympanic  wall ;  it  is  developed  with  the 
tympanum  and  lined  by  a  continuation  of  its  mucous  mem- 
brane. Into  it  open  the  mastoid  pneumatic  cells. 

THE    INTERNAL    EAR    OR    LABYRINTH. 

Within  the  internal  ear  are  the  terminal  ramifications  oi 
the  auditory  nerve.  The  internal  ear  or  labyrinth  is  divided 
into  osseous  and  membranous  parts,  the  former  enclosing  the 
latter.  Within  the  membranous  labyrinth  is  a  fluid,  the 
endolymph ;  arid  outside,  between  the  membranous  and  osseous 
labyrinths,  is  a  fluid,  theperilymph  or  liquor  Cotunnii. 

The  OSSEOUS  LABYRINTH  consists  of  the  vestibule,  the 
cochlea,  and  the  semicircular  canals. 

The  vestibule  is  the  central  part  of  the  labyrinth.  Its 
outer  wall  corresponds  to  the  inner  wall  of  the  tympanum, 
and  in  it  is  thefenestra  ovalis,  closed  by  the  base  of  the  stapes ; 
on  its  inner  wall  is  a  depression,  the  fovea  hemispherica,  per- 
forated by  several  holes  for  the  branches  of  the  auditory 
nerve;  behind  this  is  a  ridge,  the  crista  vestibuli ;  and  still 
further  back  is  the  internal  opening  of  the  aqueduct  of  the 
vestibule.  On  the  roof  is  a  depression,  the  fovea  hemi-elliptica. 
At  the  posterior  part  are  the  five  openings  of  the  semicircular 
canals,  and  at  the  anterior  part  is  the  apertura  scales  vestibuli. 

The  semicircular  canals  are  three  arched  osseous  canals 
placed  above  and  behind  the  vestibule,  opening  into  that 
chamber  by  five  rounded  apertures,  two  adjacent  canals 
having  a  common  opening.  Each  canal  forms  about  two- 
thirds  of  a  circle,  and  presents  at  one  end  a  dilated  part,  the 
ampulla.  Two  of  the  canals  are  vertical,  and  the  third  is 
horizontal. 

The  siip erior  canal  is  vertical,  and  forms  a  projection  on  the 
upper  surface  of  the  petrous  part  of  the  temporal  bone.  The 
inner  extremity  joins  the  opening  of  the  posterior  canal. 

The  posterior  canal  is  vertical,  its  upper  end  being  joined  to 
the  lower  opening  of  the  superior  canal. 

The  horizontal  or  external  canal  is  the  smallest  of  the  three, 
and  lies  horizontally  just  above  the  level  of  the  fenestra 
ovalis. 

The  cochlea  is  cone-shaped,  with  the  base  turned  to  the 


THE  EAR  235 

internal  meatus,  £nd  the  apex  opposite  the  canal  for  the 
tensor  tympani,  and  consists  of  a  tapering  spiral  canal  of 
2^  turns,  with  the  inner  wall  formed  by  its  axis  or  modiolus  : 
the  canal  is  divided  into  two  scalae  by  a  partition  of  bone  and 
membrane,  the  lamina  spiralis.  The  enclosed  arched  extremity 
of  the  cochlea  is  called  the  cupola,  and  the  first  turn  of  the 
canal  bulging  into  the  tympanum  forms  the  promontory. 
The  lamina  spiralis  ossea  ends  at  the  apex  of  the  cochlea  in  a 
small  point,  the  hamulus,  between  which  and  the  modiolus  is 
a  small  opening,  the  helicotrema,  by  which  the  two  scalae 
communicate. 

The  modiolus  is  pierced  by  small  canals  for  the  passage  of 
nerves,  and  one  larger  one,  the  central  canal  of  the  modiolus, 
passes  from  the  base  to  the  last  half-turn  of  the  cochlea.  At 
the  base  of  the  lamina  spiralis  is  a  small  canal,  the  spiral 
canal  of  the  modiolus,  which  winds  round  the  axis,  and  contains 
a  spiral  ganglionated  cord,  the  ganglion  spirale. 

The  scalse  are  known  respectively  as  the  scala  tympani 
and  the  scala  vestibuli. 

The  scala  tympani  is  the  lower  one  ,  it  commences  at  the 
fenestra  rotunda. 

The  scala  vestibuli  commences  at  the  cavity  of  the  vestibule, 
and  communicates  at  the  apex  of  the  modiolus  with  the  scala 
tympani,  by  the  helicotrema. 

The  MEMBRANOUS  LABYRINTH  consists  of  sacs  containing 
fluid  (endolymph).  The  ramifications  of  the  auditory  nerve 
are  distributed  on  the  wall.  These  membranous  sacs  com- 
plete the  septum  between  the  scala  tympani  and  the  scala 
vestibuli,  besides  enclosing  a  third  space,  the  scala  media  or 
membranous  canal  of  the  cochlea. 

The  membranous  vestibule  consists  of  two  sacs,  the  utricle 
and  the  saccule. 

The  utricle  or  common  sinus  is  larger  than  the  saccule, 
and  is  situated  in  the  posterior  and  upper  part  of  the  vestibule, 
being  contained  in  the  fovea  hemi-elliptica.  The  apertures 
of  the  membranous  semicircular  canals  open  in  the  posterior 
part.  At  the  anterior  part  is  a  thickened  spot,  the  macula 
acustica,  where  the  nerves  enter.  The  interior  contains, 
opposite  the  macula,  attached  to  the  wall,  a  small  mass  of 
calcareous  grains,  known  as  otoliths,  otoconia,  or  ear  sand. 
Below  there  is  a  canal,  which,  joined  to  a  similar  tube  from 
the  saccule,  extends  along  the  aqueduct  of  the  vestibule,  and 
ends  in  a  dilated  pouch,  the  saccus  endo-lymphaticus. 

The  saccule  is  smaller  and  rounder  than  the  utricle,  and 
lies  in  the  fovea  hemispherica.  Like  the  utricle,  it  contains 


236  THE  POCKET  ANATOMY 

a  macula  and  a  collection  of  otoliths.  Below  there  is  a  small 
canal,  canalis  reuniens,  which  connects  it  with  the  membranous 
canal  of  the  cochlea. 

The  membranous  semicircular  canals  are  about  one-third 
the  size  of  the  osseous  ones,  except  at  the  ampullae,  where 
they  dilate  to  nearly  fill  the  bony  canal.  Each  membranous 
canal  is  free  on  the  convex  surface,  the  concavity  being  fixed 
to  the  osseous  canal.  On  the  part  of  the  internal  surface  of 
the  ampulla,  corresponding  to  the  attachment  to  the  bony 
canal,  is  a  transverse  projection,  the  crista  acustica,  in  which 
some  filaments  of  the  auditory  nerve  end. 

The  membranous  cochlea  consists  of  a  membranous  tube 
divided  into  three  parts — the  scala  tympani,  scala  vestibuli, 
and  canal  of  the  cochlea  (ductus  cochlearis),  which  latter 
contains  the  organ  of  Corti,  to  which  the  auditory  nerve  is 
chiefly  distributed. 

The  lamina  spiralis  ossea  partly  divides  the  spiral  canal 
into  the  scala  tympani  and  scala  vestibuli,  the  latter  being 
superior.  The  septum  is  completed  by  the  membrana  basilaris, 
which  is  attached  to  the  outer  free  edge  of  the  lamina  spiralis 
ossea,  and  passed  outwards  to  the  wall  of  the  cochlea,  where 
it  is  fixed  to  a  thickening  of  the  periosteum  called  the  spiral 
ligament. 

The  canal  of  the  cochlea  contains  the  organ  of  Corti.  It 
lies  on  the  outer  part  of  the  scala  vestibuli,  and  is  separated 
from  it  by  the  membrane  of  Reissner,  which  passes  from  the 
lamina  spiralis  upwards  and  outwards  to  the  roof  of  the  scala. 
Thus  a  triangular  piece  is  cut  off,  bounded  internally  by  the 
membrane  of  Reissner,  externally  and  above  by  the  outer 
wall  of  the  cochlea,  and  below  by  the  basilar  membrane. 
The  canal  of  the  cochlea  is  connected  below  with  the  saccule 
by  the  canalis  reuniens,  and  above  it  terminates  in  a  blind  cone- 
shaped  extremity,  partly  bounding  the  helicotrema  and  fixed 
to  the  cupola.  The  part  of  the  lamina  spiralis  within  the 
canal  of  the  cochlea  becomes  thickened,  and  is  called  the 
limbus,  and  terminates  in  a  concave  border,  the  sulcus  spiralis. 
The  basilar  membrane  is  attached  to  the  lower  margin  of  the 
sulcus  spiralis. 

The  Auditory  Nerve. — The  auditory  nerve  divides  in  the  in- 
ternal auditory  meatus  into  two  branches,  which  perforate 
the  cribriform  plate,  and  are  distributed  to  the  cochlea  and 
the  vestibule. 

The  superior  or  vestibular  branch  supplies  :— 

1.  The  utricle. 

2.  The  ampulla  of  the  superior  semicircular  canal. 

3.  The  ampulla  of  the  horizontal  semicircular  canal. 


THE  EYE  AND  ITS  APPENDAGES  237 

The  inferior  or  cochlsar  branch  is  distributed  to  : — 

1.  The  cochlea. 

2.  The  saccule. 

3.  The  ampulla  of  the  posterior  semicircular  canal. 
Nerves  of  the  Cochlea. — The  branches  of  the  auditory  nerve 

destined  for  the  cochlea  perforate  a  number  of  foramina  at 
the  bottom  of  a  spiral  groove,  the  tractus  spiralis  foraminulen- 
ttis,  placed  in  the  centre  of  the  base  of  the  cochlea.  These 
foramina  lead  to  small  canals,  which  at  first  pass  through  the 
modiolus,  and  then  radiate  outwards  between  the  bony  layers 
of  the  lamina  spiralis,  so  passing  to  the  organ  of  Corti.  In 
the  centre  of  the  tractus  spiralis  foraminulentus  is  a  larger 
foramen  leading  to  the  central  canal  of  the  modiolus,  and 
transmitting  nerve  filaments  for  the  last  half-turn  of  the 
cochlea. 


THE    EYE   AND   ITS   APPENDAGES. 


THE   APPENDAGES   OF   THE   EYE. 

The  eye-brows  are  two  arched  eminences  over  each  orbit 
consisting  of  thickened  integuments  and  muscles,  surmounted 
by  hairs. 

The  eye-lids  are  two  movable  folds,  an  upper  and  a  lower, 
the  upper  one  being  more  movable,  which  by  their  closure 
protect  the  eye  from  injury.  When  the  eye-lids  are  open  the 
angles  of  junction  of  the  upper  and  lower  lids  are  called  re- 
spectively the  external  and  the  internal  canthus.  In  the  inner 
canthus  the  lids  are  separated  by  a  small  triangular  area,  the 
lacus  lachrymalis,  in  which  is  seen  a  pink  mass  of  fat  and 
connective  -  tissue,  the  caruncula  lachrymalis,  and  which  is 
separated  from  the  eye-ball  by  a  vertical  fold  of  conjunctiva, 
the  plica  semilunaris,  a  rudimentary  third  eye-lid;  opposite  the 
outer  edge  of  the  caruncle,  on  each  lid,  is  the  lachrymal  papilla, 
which  is  pierced  by  the  punctum  lachrymals,  the  external  open- 
ing of  the  lachrymal  canal. 

Structure  from  without  inwards :  skin,  areolar  tissue,  orbicu- 
laris  muscle  (p.  22),  tarsal  plate,  and  palpebral  ligament, 
Meibomian  glands,  and  conjunctiva;  the  upper  lid  also  con- 
tains the  aponeurosis  of  the  levator  palpebrse,  which  is 
'attached  along  the  upper  margin  of  the  tarsal  plate. 

The  tarsal  plates  are  laminae  of  condensed  connective- 
tissue  found  in  each  lid  ;  the  superior,  the  larger,  is  half  oval 


238  THE  POCKET  ANATOMY 

in  shape,  the  lower  a  narrow  oblong  strip.  In  their  substance 
are  lodged  the  Meibomian  follicles.  Each  tarsal  plate  is 
at  its  edge  (except  towards  the  ocular  fissure,  where  it  is 
free)  continuous  with  the  membranous  sheet  known  as  the 
palpebral  ligament,  while  internally  and  externally  it  receives 
the  tarsal  ligaments  (p.  22).  The  superior  tarsal  plate  re- 
ceives above  the  main  insertion  of  the  levator  palpebrse 
superioris. 

The  palpebral  ligaments  form  an  incomplete  diaphragm 
for  the  anterior  orifice  of  the  orbit ;  peripherally  they  are 
attached  to  orbital  margin  and  centrally  to  edge  of  tarsal 
plates. 

The  conjunctiva  is  the  membrane  which  forms  the  most 
posterior  layer  of  both  eye-lids,  at  the  free  edges  of  which 
it  joins  the  skin.  At  the  base  of  each  eye-lid,  where  the 
structures  enter  its  layers,  the  conjunctiva  is  reflected  on 
to  the  eye-ball,  the  lines  of  reflection  being  known  as  the 
fomices,  of  which  the  superior  is  the  deeper ;  into  it  some 
fibres  of  the  levator  palpebrae  superioris  are  inserted.  Over 
the  eye-ball,  where  it  covers  the  sclerotic,  the  conjunctiva  is 
loosely  connected,  some  connective-tissue  and  Tenon's  capsule 
intervening ;  but  at  the  corneo-sclerotic  margin  the  conjunctiva 
is  firmly  adherent,  covering  the  cornea  as  its  anterior  epithelial 
layer.  The  conjunctival  sac  has  opening  into  it  above  the 
ducts  of  the  lachrymal  gland,  and  below  the  openings  of  the 
lachrymal  canaliculi  at  the  puncta  lachrymalia. 

The  lachrymal  gland  occupies  a  depression  in  the  supero- 
external  angle  of  the  orbit ;  the  anterior  margin  is  connected 
to  the  back  part  of  the  upper  eye-lid.  The  ducts  (12  or  14) 
open  by  apertures,  placed  in  a  row,  on  the  inner  surface  of 
the  upper  lid. 

The  lachrymal  canals  commence  at  the  puncta  lachrymalia, 
which  are  the  openings  of  the  canaliculi,  and,  arching  in  the 
free  edge  of  the  lid,  pass  inwards  to  open  into  the  lachrymal 
sac. 

The  lachrymal  sac  is  placed  in  a  groove  formed  by  the 
lachrymal  bone  and  the  nasal  process  of  the  superior  maxilla, 
being  behind  the  tendo  oculi,  and  in  front  of  the  tensor  tarsi ; 
it  is  the  dilated  upper  end  of  the  nasal  duct. 

The  nasal  duct,  formed  by  the  lachrymal,  superior  maxilla 
and  inferior  turbinal  bones,  leads  from  the  lachrymal  sac  to 
the  inferior  meatus  of  the  nose,  where  it  opens,  the  aperture 
being  partly  guarded  by  a  valve  formed  of  the  mucous  mem- 
brane. It  is  about  £  inch  long,  and  is  directed  downwards, 
and  slightly  outwards  and  backwards. 


THE  EYE  AND  ITS  APPENDAGES  239 


THE    BYE. 


The  eye-ball  is  contained  within  the  orbit;  its  shape  is 
spherical,  with  the  segment  of  a  smaller  sphere,  corresponding 
to  the  cornea,  superimposed  anteriorly. 

The  eye-ball  consists  of  three  coats  enclosing  three  re- 
fractive media  : 


IChoroid. 
Ciliary  body. 
Iris. 
yd  coat    ...  ...  ...     Retina. 

The  refractive  media  are  :  — 

1.  Aqueous  humour. 

2.  Vitreous  body. 

3.  The  lens. 

Covering  the  posterior  £  of  the  eye-ball  is  a  layer  of  fascia, 
the  capsule  of  Tenon,  continuous  posteriorly  with  the  sclerotic 
at  the  entrance  of  the  optic  nerve,  whilst  anteriorly  at  the 
corneo-sclerotic  junction  it  is  connected  with  it  by  loose  tissue 
only,  and  is  pierced  by  the  tendons  of  the  muscles  of  the  eye- 
ball. It  is  connected  with  the  eye-ball  only  by  delicate  con- 
nective-tissue, the  interval  constituting  an  extensive  lymph- 
spa^e  and  forming  a  free  socket  in  which  the  eye-ball  glides. 

The  sclerotic  coat  is  opaque  and  fibrous,  and  occupies  the 
posterior  £  of  the  eye-ball,  being  continuous  in  front  with  the 
cornea,  at  the  corneo-sclerotic  junction. 

The  outer  surface  is  white  and  smooth,  receiving  the  inser- 
tions of  the  recti  and  obliqui  muscles. 

The  inner  surface  is  of  a  light-brown  colour,  due  to  a  lining 
of  pigmented  connective-tissue,  the  membrana  fusca,  which  is 
connected  by  fine  filaments  to  the  choroid  coat.  Between 
the  sclerotic  and  choroid  coats  is  a  lymph-space  transmitting 
branches  of  the  ciliary  vessels  and  nerves. 

The  optic  nerve  passes  through  the  posterior  part  of  the 
sclerotic,  about  $  inch  internal  to  the  axis  of  the  eye-ball,  the 
point  of  perforation  being  called  the  lamina  cribrosa.  At  its 
entrance,  the  outer  sheath  of  the  nerve  blends  with  the 
sclerotic  coat. 

The  sclerotic  is  thickest  at  its  posterior  part,  gradually 
thinning  until  about  £  inch  from  the  cornea,  where  it  thickens 
hgain. 


240  THE  POCKET  ANATOMY 

Close  to  the  junction  of  the  cornea  with  the  sclerotic  is 
a  small  circumferential  lymph -space,  called  the  canal  oj 
Schlemm. 

The  bloodvessels  of  the  sclerotic  are  few  in  number,  but  near 
its  junction  with  the  cornea  there  is  a  vascular  zone  derived 
from  the  anterior  ciliary  branches  of  the  ophthalmic  artery. 

The  cornea  is  the  anterior  transparent  part  of  the  outer 
coat  of  the  eye-ball,  occupying  about  fc  of  the  circumference 
of  the  globe.  It  projects  forward  beyond  the  curvature  of  the 
sclerotic,  being  the  segment  of  a  smaller  sphere.  The  posterior 
surface  is  concave,  and  projects  further  backwards  than  the 
anterior  convex  surface,  being  overlapped  by  the  edge  of  the 
sclerotic ;  this  surface  forms  the  anterior  boundary  of  the 
anterior  chamber  of  the  eye,  containing  the  aqueous  humou-r. 

The  cornea  is  clothed  on  its  anterior  convex  surface  by  the 
conjunctiva,  which  here  consists  only  of  an  epithelial  layer. 

At  the  circumference  of  the  cornea  some  of  the  fibres  which 
form  its  stroma  are  continued  backwards  and  outwards  into 
the  choroid,  sclerotic,  and  iris;  those  going  to  the  iris  are 
called  the  ligamentum  pectinatum  iridis  or  the  pillars  of  the 
iris;  they  form  an  annular  meshwork  enclosing  a  series  of 
lymph-spaces  (spaces  of  Fontana)  which  communicate  with 
the  anterior  chamber. 

The  choroid  coat  is  situated  between  the  sclerotic  and  the 
retina,  and  is  the  vascular  tunic  of  the  eye-ball.  It  is  con- 
tinued anteriorly  into  the  iris,  but  before  its  junction  it  forms 
a  number  of  projections,  folding  inwards,  and  arranged  in  a 
circle,  known  as  the  ciliary  processes. 

The  choroid  coat  is  thickest  behind,  where  it  is  pierced  by 
the  optic  nerve. 

Externally  it  is  connected  to  the  sclerotic  by  loose  connec- 
tive-tissue traversed  by  vessels  and  nerves  as  before  described. 
Internally  it  is  covered  by  the  pigmented  cells  of  the  retina. 

The  choroid  consists  of  bloodvessels  connected  together  by 
loose  connective-tissue,  and  containing  large  branched  and 
pigmented  cells. 

It  is  made  up  of  two  layers,  an  outer  and  an  inner.  The 
outer  part  contains  the  larger  branches  of  the  vessels.  The 
arteries,  the  short  posterior  ciliary,  pierce  the  sclerotic  coat 
close  to  the  optic  nerve,  pass  forwards,  and  bend  inwards  to 
end  in  the  inner  layer. 

The  veins,  vasa  vorticosa,  are  external  to  the  arteries  and 
join  together  into  four  or  five  principal  trunks,  which  pierce 
the  sclerotic  midway  between  the  cornea  and  the  optic  nerve 

The  inner  coat,  or  tunica  Ruyschiana,  is  formed   by  the 


THE  EYE  AND  ITS  ATPENI'-IGES  241 

capillary  endings  of  the  vessels  of  the  outer  coat ;  they  pass 
forwards  to  £  inch  from  the  cornea,  joining  those  of  the 
ciliary  processes. 

The  Ciliary  Body  consists  of  the  ciliary  processes  and  the 
ciliary  muscle. 

The  ciliary  processes  are  of  the  same  structure  as  the  rest 
of  the  choroid.  They  are  about  seventy  in  number,  and  are 
placed  in  corresponding  depressions  upon  the  surface  of  the 
vitreous  humour,  and  upon  the  suspensory  ligament  of  the  lens. 
The  bloodvessels  are  derived  from  the  anterior  ciliary  branches. 

The  ciliary  muscle  consists  of  two  sets  of  involuntary 
muscular  fibres,  radiating  and  circular.  (Nerve  supply  from 
3rd  cranial.) 

The  radiating  arise  by  tendon  from  the  sclerotic  close  to  the 
junction  with  the  cornea,  between  the  spaces  of  Fontana  and 
the  canal  of  Schlemm,  and  are  inserted  into  the  choroid 
opposite  the  ciliary  processes. 

The  circular:  a  zone  of  circular  fibres  internal  to  the 
radiating,  at  the  base  of  the  ciliary  processes. 

The  iris  is  the  coloured  membrane  suspended  in  the  aque- 
ous humour  behind  the  cornea  and  in  front  of  the  lens.  In 
the  centre  is  an  aperture,  the  pupil. 

It  is  connected  at  its  circumference  to  the  choroid,  being 
continuous  with  it ;  and  anterior  to  this  it  is  attached  to 
the  cornea  by  the  pillars  of  the  iris,  or  ligamentum  pec- 
tinatum. 

The  anterior  surface  is  coloured  and  marked  by  wavy  lines 
converging  towards  the  free  edge  of  the  pupil. 

The  posterior  surface  is  darkly  pigmented  (uvea]  and 
marked  with  folds  prolonged  from  the  ciliary  processes. 

The  framework  of  the  iris  is  a  delicate  stroma  of  connec- 
tive-tissue, containing  bloodvessels,  nerves,  pigment  cells, 
and  two  groups  of  involuntary  muscular  fibres : — 

The  sphincter,  a  narrow  band  of  fibres  placed  posteriorly 
close  to  the  pupil  (3rd  nerve) . 

The  dilator,  commencing  at  the  outer  margin  of  the  iris, 
with  the  fibres  converging  towards  the  pupil  (sympathetic 
nerve). 

The  bloodvessels  of  the  iris  consist  of  the  two  long  ciliary  and 
the  anterior  ciliary  arteries ;  the  former  pierce  the  sclerotic 
close  to  the  optic  nerve,  and  pass  forwards  in  the  lymph- 
space  between  the  lamina  fusca  of  the  sclerotic  and  the  lamina 
supra-choroidea  of  the  choroid  to  enter  the  outer  surface  of 
the  iris,  having  previously  divided  into  two  branches.  They 
anastomose  with  the  corresponding  vessels  of  the  opposite 

10 


242  THE  POCKET  ANATOMY 

side,  and  with  those  from  the  vascular  zone  of  the  sclerotic, 
formed  by  the  anterior  ciliary  arteries.  These  form  the 
circulus  iridis  major.  Small  branches  from  this  circle  converge 
towards  the  pupil,  and  freely  anastomose  with  one  another, 
forming  the  circulus  iridis  minor. 

The  veins  follow  the  same  arrangement  as  the  arteries,  and 
communicate  with  the  canal  of  Schlemm. 

The  nerves  of  the  choroid  and  iris  are  about  fifteen  in 
number,  and  are  the  ciliary  nerves,  from  the  lenticular  ganglion 
and  the  nasal  branch  of  the  5th  ;  they  follow  very  closely  the 
course  of  the  bloodvessels,  and,  reaching  the  ciliary  body, 
form  a  plexus,  sending  twigs  to  the  ciliary  muscle,  iris,  and 
cornea. 

The  retina  is  the  expanded  termination  of  the  optic  nerve, 
and  forms  the  innermost  tunic  of  the  eye.  It  reaches  forwards 
nearly  as  far  as  the  ciliary  processes,  where  it  ends  in  a  saw- 
edged  border,  the  ora  serrata,  and  from  this  border  there  is 
prolonged  a  thin  layer  as  far  as  the  ciliary  processes,  which 
blends  with  the  uvea  of  the  iris.  This  prolongation  contains 
no  nerve-fibres,  and  is  called  the  pars  ciliaris  retina. 

The  outer  surface  is  covered  with  uveal  pigment -cells 
(formerly  described  as  part  of  the  choroid). 

The  inner  surface  contains  : — 

The  macula  lutea,  or  yellow  spot,  situated  in  the  axis  of  the 
globe. 

Thefovea  centralis,  a  depression  in  the  preceding. 

Theporus  opticus,  or  disc,  about  ^  inch  to  the  inner  side  of 
the  yellow  spot,  where  the  optic  nerve  enters,  and  from  which 
its  fibres  radiate ;  coursing  over  the  optic  disc  may  be  seen 
the  central  vessels  of  the  retina. 

Bloodvessels  of  the  retina : — 

The  central  artery  of  the  retina  passes  through  the  optic 
nerve,  and  reaches  the  inner  surface  of  the  retina  through 
the  disc.  It  here  divides  into  two  branches,  an  ascending 
and  descending,  and  each  of  these,  again,  into  an  outer  or 
temporal  division,  and  an  inner  or  nasal. 

The  outer  branches  give  small  offsets  to  end  in  capillaries 
round  the  fovea.  The  rest  of  the  branches  are  distributed, 
as  capillaries,  to  the  retina,  as  far  as  the  ora  serrata,  but  the 
smaller  branches  do  not  anastomose  with  one  another  or 
with  any  other  vessels.  The  veins  follow  the  same  distribu- 
tion as  the  arteries. 

The  vitreous  body  is  a  soft  gelatinous  substance  occupying 
about  $  of  the  eye-ball.  It  supports  the  retina  behind,  and 
is  hollowed  out  in  front  for  the  lens 


THE  EYE  AND  ITS  APPENDAGES  243 

Between  the  retina  and  the  vitreous,  and  enclosing  the  latter 
except  in  front,  is  a  thin  capsule,  the  hyaloid  membrane. 

This  membrane  passes  forwards  in  front  to  the  anterior 
part  of  the  margin  of  the  lens.  It  becomes  stronger  in  this 
part,  and  is  called  the  zonule  of  Zinn,  the  zonula  ciliaris,  or  the 
suspensory  ligament  of  the  lens. 

The  zonule  commences  near  the  ciliary  processes,  and 
passes  forwards  to  the  front  of  the  lens,  and  is  attached  in 
front  to  the  lens  capsule.  In  addition  some  fibres  are  attached 
to  the  extreme  edge  of  the  lens,  and  others  become  continuous 
with  the  posterior  part  of  the  capsule. 

The  interstices  between  these  fibres  are  occupied  by  fluid, 
but  after  death  they  may  be  distended  with  air,  and  an 
appearance  of  a  canal  (canal  of  Petit)  encircling  the  lens  is 
produced. 

Extending  forwards  from  the  optic  disc  through  the  vitreous, 
as  far  as  the  capsule  of  the  lens,  is  the  canal  of  Stilling,  or 
hyaloid  canal,  which  is  the  remains  of  a  passage  for  a  branch 
from  the  central  artery  of  the  retina  in  the  foetus. 

The  lens  is  a  transparent  bi-convex  body  enclosed  in 
a  transparent  membrane,  the  lens  capsule.  It  is  in  contact 
anteriorly  with  the  iris ;  posteriorly  it  rests  in  a  depression 
in  the  vitreous  body,  and  it  is  surrounded  by  the  suspensory 
ligament  or  zonule  of  Zinn.  It  is  about  £  inch  in  diameter, 
and  about  \  inch  thick. 

The  lens  capsule  is  the  structureless  membrane  enclosing 
the  lens,  thick  in  front  near  its  circumference,  where  it  is 
strengthened  by  the  fibres  of  the  zonule,  but  very  thin 
posteriorly. 

The  aqueous  humour  and  the  aqueous  chambers. — The 
aqueous  humour  occupies  the  space  between  the  anterior 
surface  of  the  lens  capsule  and  the  posterior  surface  of  the 
cornea. 

The  iris  divides  the  chamber  into  two  parts,  known  as  the 
anterior  and  posterior  chambers. 

The  anterior  chamber  is  bounded  in  front  by  the  cornea, 
behind  by  the  iris,  and  opposite  the  pupil  by  the  anterior 
part  of  the  lens. 

The  posterior  chamber  is  the  triangular  interval  at  the  cir- 
cumference of  the  lens  between  the  ciliary  processes,  the  iris, 
and  the  zonule  of  Zinn, 


16— a 


INDEX 


ABDOMINAL  aorta,  82 

ring,  external,  44 
internal,  223 
Abducens  nerve,  151 
Abductor  indicis  muscle,  40 
hallucis  muscle,  58 
minimi  digiti  muscle   39 

pedis  muscle, 

58 

pollicis  muscle,  39 
Accessorius  muscle,  58 

ad  sacro-lumbalem,  42 
Accessory  obturator  nerve,  169 
Acromio-clavicular  articulation,  9 
Acromio-thoracic  artery,  74 
Aditus  ad  antrum,  232 
Adductor  brevis  muscle,  52 

obliquus  hallucis  muscle,  58 
longus  muscle,  52 
magnus  muscle,  52 
obliquus  pollicis  muscle,  39 
transversus  hallucis  muscle, 

58  . 
pollicis  muscle, 

39 

Alar  ligaments  of  the  knee,  17 
Ampulla,  membranous,  235 

of  the  semicircular  canals, 

Amygdaloid  lobe  of  cerebellum,  124 
Anastomotic  artery  of  brachial,  76 
femoral,  92 
Anconeus  muscle,  38 
Angular  artery,  67 

vein,  99 
Ankle-joint,  18 
Annular  ligament  of  ankle,  anterior, 

57 

external,  57 

internal,  57 

of  wrist,  anterior, 

13,35 
posterior, 

13,36 

Annulus  ovahs,  205 
Anterior  commissure  of  brain,  138 
Anti-helix,  230 
Anti-tragus,  230 
Aorta,  79 


Aorta,  abdominal,  82 

thoracic,  80 
Aortic  arch,  79 

opening,  46 
plexus,  180 
sinus,  79 
Aperture  of  the  aorta,  46 

inferior    vena    cava, 

46 

coronary  Arteries,  206 
Eustachian  tube,  232 
for  the  femoral  artery,  53 
of  the  larynx, 210 

nares,  186,  229 
oesophagus,  187 
pulmonary  artery,  205 
veins,  206 
Aponeurosis,  epicranial,  21 

of  external  oblique,  44 

over  femoral  artery,  53 

of  internal  oblique,  44 

lumbar,  45 

of  the  pharynx,  186 

plantar,  57 

of  the  soft  palate,  183 

temporal,  25 

of      the       transversalis 

muscle,  44 
vertebral,  41 

Appendages  of  the  eye,  237 
Appendix  auriculae,  200,  204,  206 

vermiformis,  190 
Aqueduct  of  Sylvius,  126 

of  the  vestibule,  234 
Aqueous  humour,  243 
Arachnoid  membrane  of  the  brain,  140 

of  cord,  116 

Arbor  vitae  cerebelli,  126 
Arch,  crural  or  femoral,  50 
of  aorta,  79 
of  diaphragm,  46 
palmar  deep,  77 

superficial,  78 
plantar,  97 
Arciform  fibres,  119 
Arteria  acromialis  thoracica,  74 

anastomotica  brachialis,  76 

magna,  90 
angularis  faciei.  67 


INDEX 


245 


\rter.,  aorta  abdominalis,  82 

thoracica,  80 
articulates  inferipres,  93 
superiores,  93 
articularis  azygos,  93 
auricularis  posterior,  68 
auditoria,  73 
axillaris,  73 
basilaris,  73 
brachiahs,  75 
bronchiales,  81 
buccalis,  70 
capsularis  inferior,  84 
media,  83 
superior,  82 

carotis  communis  dextra,  64 
sinistra,  64 
externa,  65 
interna,  73 

carpi  ulnaris  anterior,  78 
posterior,  78 
radialis  anterior,  76 
posterior,  76 
centralis  retinae,  72 
cerebelli  inferior,  62 

anterior,  73 
superior,  73 
cerebri  anterior,  72 
media,  72 
posterior,  73 
cervical  is  ascendens,  62 
profunda,  64 
choroidea  cerebri,  72 
ciliares  anteripres,  72 
posteriores,  72 
circumflexa  anterior,  75 
externa,  91 
ilii  interna,  89 

superficialis,  91 
interna,  91 
posterior,  75 
coeliaca,  82 
colica  dextra,  84 
media,  84 
sinistra,  84 
comes  nervi  ischiadici,  89 

phrenici,  63 
communicans  cerebri  anterior, 

72 

posterior,  72 
palmaris,  79 
plantaris,  96 
coronaria  dextra,  206 

labii  inferipris,  67 
superioris,  67 
sinistra,  207 
ventriculi,  82 
corporis  bulbosi,  88 


Arter.,  corporis  cavernosi,  88 
cremasterica,  89 
crico-thyroidea,  66 
cystica,  83 
deferentialis,  86 
dentalis  anterior,  70 
inferior,  70 
superior,  70 
diapbragmatica,  63,  82 
digitales  manus,  79 

pedis,  96,  97 
dorsales  pollicis,  77 
dorsalis  carpi  radialis,  77 
ulnaris,  78 
hallucis,  95 
indicis,  77 
lingua?,  66 
pedis,  94 
penis,  88 
scapulae,  74 
epigastrica,  89 

superficialis,  90 
ethmoidalis  anterior,  72 
posterior,  72 
facialis,  66 
femoralis,  90 
frontalis,  72 
gastricae,  87 
gastro-duodenalis,  83 

epiploica  dextra,  83 
sinistra,  83 
glutea,  go 

haemorrboidalis  inferior,  87 
media,  86 
superior,  85 
hepatica,  82 
hyoidea  lingualis,  66 

thyroideae,  66 
hypogastrica,  86 
ileo-colica,  84 

lumbalis,  88 
iliaca  communis,  85 
externa,  88 
interna,  86 
incisoria,  70 
infra-orbitalis,  70 

scapularis,  63 
innoroinata,  80 

intercostales  anteriores,  63,  81 
rami    anteriores, 

81 

posteriores,  81 
intercostalis  superior,  64 
interossea,  78 

anterior,  78 
posterior,  7-; 
interosseas  manus,  77 
pedis,  95 


246 


INDEX 


Artei.,  intestinales,  84 
ischiadica,  89 
labialis  inferior,  67 
lachrymalisj  71 
laryngealis  inferior,  62 
superior,  66 
Hngualis,  66 
lumbales,  85 

rami  anteripres,  85 

posteriores,  85 
malleolares,  94 
mammaria,  externa,  74 
interna,  63 
masseterica,  70 
maxillaris  interim,  69 
mediana,  78 
mediastinae,  81 
rneningea  media,  69 
parva,  69 
meningeae  anteriores,  71 

posteriores,  61 
mesenterica  inferior,  84 
superior,  83 
metacarpa  radialis,  77 
ulnaris,  78 
metatarsea,  95 
musculo-phrenica,  63 
mylo-hyoidea,  70 
nasalis,  72 

lateralis,  67 
septi,  70 

nutntia  femoris,  92 
humeri,  75 
tibiae,  96 
obturatoria,  86 
occipitalis,  67 
oesophageales,  81 
ophthalmic;!,  71 
ovariana,  84 
palatina  inferior,  67 
superior,  70 
palmaris  prpfunda,  77 
palpebrahs  inferior,  72 
superior,  72 
pancreaticae,  83 
pancreatico-duodenalis,  83 
perforantes  femorales,  92 

mam  ma  rise   in- 

ternal, 63 
manus,  77 


. 

pencardiacae,  81 
perinaei  superficialis,  87 
p«ronea,  96 

anterior,  96 

pharyngea  ascendens,  68 
phrenicae  inferipres,  82 
superiores,  63 


Arter. ,  plantaris  externa,  97 

interna,  96 
poplitea,  92 
princeps  cervicalis,  68 

pollicis,  77 
profunda  cervicis,  64 

femoris,  QI 

inferior,  76 

superior,  75 
pterygoideas,  70 
pterygo-palatina,  70 
pudenda  externa,  91 

interna,  87 
pulmonalis,  214 

dextra,  215 
sinistra,  215 
pylori ca,  83 
radialis,  76 

mdicis,  77 
ranina,  66 
recurrens  interossea  posterior, 

radialis,  76 
tibialis,  97 
ulnaris  anterior,  78 
posterior,  7! 
renales,  84 
sacra-media,  85 

lateralis,  88 

scapularis  posterior,  63 
sciatica,  89 
sigmoidea,  85 
spermatica,  84 
spheno-palatina,  70 
spinales  posteriores,  6i 
spinalis  anterior,  62 
splenica,  83 
sterno-mastoidea,  66 
stylo-mastoidea,  68 
subclavia  dextra,  59 
sinistra,  59 
sublingualis,  66 
submentalis,  67 
subscapularis,  74 
superficialis  cervicalis,  63 
perinaei,  88 
vola^,  76 
supra-orbitalis,  72 

scapularis,  62 
tarsea,  94 

temporales  profundae,  69 
temporalis,  anterior,  69 
deep,  70 
media,  69 
posterior,  69 
superficialis,  68 
thoracica  acromialis,  74 
alaris,  74 


INDEX 


247 


After.,  thoracica  longa,  74 

superior,  74 
tbyroidea  ima,  80 

inferior,  62 
superior,  66 
tibialis  antica,  93 
postica,  94 
tonsillaris,  67 
transversalis  colii,  63 
facie  i,  69 
perina-i,  87 
pontis,  73 
tympanica,  69,  71 
ulnaris,  77 
uterina,  86 
vaginalis,  86 
vertebralis,  61 
vesicalis  inferior,  86 
media,  86 
superior,  86 
vidiana,  70 
Articular  popliteal  arteries,  93 

nerves,  173,  174 

Articulation,  acromio-clavicular,  9 
astragalo-scaphoid,  19 
atlo-axoid,  3 
of    bones  of   the    tym- 
panum, 231 

calcaneo-astragaloid,  19 
cuboid,  19 

scaphoid,  19 
of  carpal  bones,  12 
carpo-metacarpal,  13 
of  cervical  vertebra,  2 
chondro-costal,  6 
sternal,  5 

of  coccygeal  bones,  8 
coraco-clavicular,  9 
of  costal  cartilages,  6 
costo-clavicular,  9 
vertebral,  5 
crico-aryteiT'id,  208 

thyroid,  209 
of  cuneiform  bones,  19 
cuneiform  to  cuboid,  19 
to    scaphoid, 

of  dorsal  vertebrae,  3 
femoro-tibial  or  knee,  15 
humero     -    cubital     or 

elbow,  10 

ilio-femoral  or  hip,  14 
of  lower  jaw,  4 
of  lumbar  vertebrae,  2 
of  the  metacarpal  bones, 

metacarpo  -  phalangeal, 
14 


Articulation,  metatarsal,  20 

metatarso  -  phalangeal, 

20 

occipito-atlpid,  3 
axial,  4 
os  calcis  to  cuboid,  19 

to  scaphoid,  19 
peroneo-tibial,  17 
phalangeal  of  fingers,  14 

of  toes,  21 

of  pubic  symphysis,  8 
radio-carpal  or  wrist,  12 
cubital  inferior,  n 
superior,  1 1 
sacro-coccygeal,  8 
iliac,  7 
vertebral,  6 
scaphoid  to  cuboid,  19 
to    cuneiform, 

T9 

scapulo-humeral,  10 
sterno-clavicular,  8 
tarso- metatarsal,  20 
temporo-maxillary,  4 
of  the  thumb,  13 
tibio-tarsal  or  ankle,  18 
of  vertebrae,  2 

Arcus  externus  diaphragmatis,  46 
internus  diaphragmatis,  46 
Aryteno-epiglottidean  folds,  209 
Arytenoid  cartilages,  208 

muscle,  31 
Ascending  cervical  artery,  62 

vein,  10 1 
colon,  190 

pharyngeal  artery,  68 
vein,  10* 

Attollens  aurem  muscle,  22 
Attrahens  aurem  muscle,  22 
Auditory  artery,  73 

nerve,  153,  236 
nucleus,  123 
Auricle  of  the  ear,  230 
Auricles  of  the  heart,  204 

left,  206 
right,  204 

Auricular  artery,  posterior,  68 
nerve  of  vagus,  155 
nerves,  great,  160 

inferior,  147 
superior,  147 
posterior,  152 
vein,  loo 
Auriculo-temporal  nerve,  147 

ventricular    aperture,    left, 

206 

ventricular  aperture,  right, 
205 


248 


INDEX 


Auricularis  magnus  nerve,  160 
Axillary  artery,  73 
fascia,  32 
vein,  102 

Axis,  coeliac,  of  artery,  8a 
of  cochlea,  235 
thyroid,  62 
Azygos,  artery,  93 
veins,  104 
uvulae  muscle,  30 

Base  of  brain,  129 
Basilar  artery,  73 

membrane,  237 
Basilic  vein,  102 
Biceps  femoris  muscle,  54 

flexor  cubiti  muscle,  35 
Bicuspid  teeth,  181 
Bile  ducts,  193 
Biventral  lobe,  125 
Bladder,  218 

interior  of,  219 
connections  of,  219 
ligaments  of,  48,  191 
Bones  of  the  ear,  232 
Brachial  aponeurosis,  35 
artery,  75 
plexus,  i6x 
veins,  102 

Brachialis  anticus  muscle,  35 
Brain,  base  of,  129 

membranes  of,  139 
Broad  uterine  ligament,  227 
Bronchial  arteries,  81 
glands,  113 
veins,  105 
Bronchus,  left,  212 

right,  212 

Brunner's  glands,  190 
Buccal  artery,  70 
nerve,  146 

Buccinator  muscle,  24 
Bulb  of  the  urethra,  221 

artery  of,  88 
Bulbus  olfactorius,  141 

Caecum  coli,  190 

connections  of,  190 
Calamus  scriptorius,  120 
Calices  of  the  kidney,  217 
Calciform  papillae,  217 
Canal,  Hunter's,  53 

of  cochlea,  236 

of  Petit,  243 

of  spinal  cord,  116 

of  Stilling,  243 

of  the  tensor  tympani,  232 
Canine  teeth,  181 


Capsular  arteries,  inferior,  84 
middle,  83 
superior,  8  a 
ligament  of  the  hip,  14 
knee,  16 
shoulder,  10 
thumb,  13 
Capsule  of  crystalline  lens,  243 
of  Glisson.  194 
suprarenal,  217 
Caput  gallinaginis,  221 
Cardiac  nerve,  inferior,  178 
middle,  178 
of  pneumogastric,  156 
superior,  176 
plexus,  179 
veins,  106 
Carneae  columnse,  199 
Carotid  artery,  external,  65 
internal,  73 
left  common,  64 
right  common,  64 

Carpal  artery,  radial  anterior,  76 
posterior,  76 
ulnar  anterior,  78 
posterior,  78 
Carpo-metacarpal  articulation,  13 
Cartilage,  arytenoid,  208 
cricoid,  208 
cuneiform,  209 
of  the  ear,  230 
thyroid,  207 
triangular     of    the    nose, 

228 

Cartilages  of  the  nose,  228 
of  Santorini,  208 
of  trachea,  211 
Caruncula  lachrymalis,  237 
Carunculae  myrtiformes,  225 
Cauda  equina,  1 14 
Cava  inferior,  105 
superior,  103 
Cavernous  body,  221 

artery  of,  88 
plexus,  177 
sinus,  98 

Central  artery  of  the  retina,  73 
passage  of  cochlea,  235 
lobe  of  brain,  133 
Centrum  ovale  cerebri,  134 
Cephalic  vein,  102 
Cerebellar  arteries,  inferior,  62 
superior,  73 

Cerebellum,  form  of,  124 
lobes  of,  12  4 
structure  of,  125 
Cerebral  artery,  anterior,  72 


INDEX 


249 


Cerebral  artery,  middle,  72 

posterior,  73 

Cerebrum,  division  into  lobes,  131 
form  of,  130 
interior,  134 
structure,  138 
<"'Tvical  fascia,  26 

ganglion,  inferior,  178 
middle,  177 
superior,  176 
glands,  in 
nerves,    anterior    branches, 

159 
posterior    branches, 

159 

plexus  of  nerves,  159 
plexus     of     nerves,      deep 

branches,  161 
plexus  of  nerves,  superficial, 

160 

Cervical  is,  ascendens  artery,  62 
muscle,  42 
.     vein,  101 
profunda  artery,  64 
vein,  101 

superficialis  nerve,  160 
Cervico-facial  nerve,  153 
Cervix  uteri,  226 
Chamber  of  the  eye,  anterior,  243 
posterior,  2(3 
Check  ligaments,  4 
Chiasma  of  the  optic  nerves,  129 
Chondro-costal  articulations,  6 
sternal  articulations,  5 
Chorda  tympani  nerve,  152 
Chordae  tendineae,  205 
Chordae  vocales,  210 
Chorda:  Willisii,  98 
Choroid  arteries  of  the  brain,  72 
coat  of  the  eye,  240 
plexuses  of  the  brain,  137 
veins  of  the  eye;  240 
brain,  97 

Ciliary  arteries,  72 
muscle,  241 

processes  of  the  choroid,  241 
nerves  of  nasal,  143 

of  lenticular  ganglion, 

Circle  of  Willis,  7^ 
Circular  sinus,  98 
Circumflex  artery,  anterior,  75 
external,  91 
internal,  91 
posterior,  75 
iliac  artery,  deep,  89 

superficial,  91 
e,  162 


Clavicular  cutaneous  nerves,  160 
Clitoris,  225 
Coccygeal  muscle,  49 
nerve,  170 

Cochlea,  canal  of,  236 
nerves  of,  237 
Coeliac  artery,  82 

plexus,  1 80 
Colic  artery,  left,  84 

middle,  84 
right,  84 
veins,  108 
Colon,  190,  ic  i 
Columnar  carneae,  205 
Columns  of  the  cord,  115 
Comes  nervi  ischiadici  artery,  89 

phrenici  artery,  63 
Commissure,  anterior,  138 

of  the  cerebellum,  125 
of  the  cord,  116 
great,  135 

of  the  optic  nerves,  129 
posterior,  128 
soft,  128 
Commissural  fibres  of  the  medulla, 

119 
Communicating    artery    of   anterior 

cerebral,  72 
Communicating  artery  of  posterior 

cerebral,  72 
Communicating  artery  in  the  palm, 

Communicating  peroneal  nerve,  175 
Compressor  muscle  of  the  nose,  23 

of  the  urethra,  49 
Concha,  230 
Conjoined  tendon,  44 
Conjunctiva,  238 
Conoid  ligament,  9 
Constrictor  muscle,  inferior,  29 
.     middle,  29 

superior,  29 
Conus  arteriosus,  205 
medullaris,  114 
Convolutions  of  the  brain,  131 

of  hemisphere,  131 

of  longitudinal  fissure, 

132 
Coraco-brachialis  muscle,  34 

clavicular  articulation,  9 
humeral  ligament,  9 
Cornea,  240 
Cornicula  laryngis,  210 
Cornua  of  gray  crescent,  116 

of  lateral  ventricles,  135 
Corona  glandis,  221 
Coronary  vessels  of  the  heart,  206 
of  the  lips,  67 


250 


INDEX 


Coronary    artery    of    the     stomach, 

82 

ligament  of  the  liver,  192 
plexus    of    the    stomach, 

1 80 

plexus  of  the  heart,  1 80 
sinus,  106 

Corpora  albicantia,  129 
Arantii,  205 
cavernosa,  221 
geniculata,  128 
olivaria,  120 
quadrigemina,  127 
restiformia,  119 
striata,  137 
Corpus  callosum,  134 

dentatum  cerebelli,  126 
fimbriatum  uteri,  227 
geniculatum  externum,  128 
internum,  128 
Highraori,  223 
olivare,  120 

spongiosum  urethrae,  221 
thyroideum,  215 
Corrugator  supercilii  muscle,  22 
Costo-clavicular  ligament,  9 
coracoid  membrane,  32 
transverse  ligaments.  5 
Cotunnius,  nerve  of,  145 
Cotyloid  ligament,  15 
( 'overed  band  of  Reil,  135 
Cowper's  glands,  220 
Cremaster  muscle,  44 
Cremasteric  artery,  89 
fascia,  222 

Cribriform  fascia,  50 
Crico-arytenoid  artirulation,  208 

muscle,  lateral,  31 

posterior,  31 
thyroid  articulation,  208 
membrane,  209 
muscle,  30 

Cricoid  cartilage,  209 
Crista  vestibuli,  236 
Crucial  ligaments,  16 
Crura  cerebelli,  125 
cerebri,  126 
of  the  diaphragm,  46 
of  the  fornix,  136,  1 37 
Crural  arch,  50 

deep,  51 
canal,  50 
nerve,  169 
ring,  50 
sheath,  50 
Cystic  artery,  83 
duct,  194 
plexus  of  nerves,  180 


Decussation  of  the  pyramids,  i»o 
Deep  cervical  artery,  64 

crural  arch,  51 

transverse  muscle  of  perinaeun^ 

49 

Deferential  artery,  36 
Deltoid  ligament,  18 

muscle,  33 

Dental  artery,  anterior,  70 
inferior,  70 
superior,  70 

Dental  nerve,  superior,  144,  145 
inferior,  147 
posterior,  144 
Dentate  ligament,  117 
Depressor  anguh  oris  muscle,  24 

labii  inferioris  muscle,  24 
alee  nasi  muscle,  23 
Descendens  hypoglossi  nerve,  158 
Descending  colon,  191 
Diaphragm,  46 

arteries,  62,  83 
plexus  of,  1 80 
Digastric  muscle,  28 
nerve,  152 

Digital  arteries  of  plantar,  97 
of  radial,  77 
of  ulnar,  79 
nerves  of  median,  164 
of  plantar,  174 
of  radial,  165 
of  ulnar,  164 
Dilatator  muscle  of  the  n  'f,e,  24 

of  the  pupil,  241 
Dorsal  artery  of  the  foot,  94 
of  the  penis,  88 
of  the  scapula,  74 
of  the  tongue,  66 
nerves,     anterior      branches, 

*59 

posterior  branches,  158 
cutaneous  of  the  hand, 

164 

of  the  penis,  172 
Dorsi-spinal  veins,  105 
Douglas's  fold,  45 
Ductus  ad  nasum,  239 
arteriosus,  214 
communis  choledochus,  194 
cysticus,  194 
ejacularorius,  224 
hepaticus,  194 
lymphaticus,  in 
pancreaticus,  195 
reunions,  236 
Riviniani,  185 
Stensonis,  184 
thoracicus.  no 


INDEX 


251 


Ductus  Whartonii,  185 
Duodenum,  connections,  188 
Dura  mater,  139 

of  the  cord,  116 

Ear,  external,  230 
internal,  234 
Eighth  nerve,  153 
Ejaculator  urinae  muscle,  49 
Elbow  joint,  10 
Eminentia  collaterals,  136 
Encephalon,  117 
Endocardium,  205 
Endolymph,  234 
Epididymis,  223 
Epigastric  artery,  89 

superficial,  90 
veins,  109 
Epiglottis,  210 
Erector  clitoridis  muscle,  49 
penis  muscle,  49 
spinae  muscle,  42 
Ethmoidal  arteries,  72 
Eustachian  tube,  cartilaginous  part, 

232 

osseous  part,  232 
valve,  204 
Extensor      carpi      radialis      brevior 

muscle,  37 

Extensor      carpi      radialis      longior 
muscle,  37 

carpi  ulnaris  muscle,  38 
digiti  minimi  muscle,  37 
Extensor  digitorum  brevis  muscle,  57 
communis 

muscle,  37 
1  o  n  gu  s     pedis 

muscle,  55 
indicis  muscle,  38 
ossis  metacarpi  muscle,  -;8 
proprius  hallucis  muscle^  5. 
brevis  pollicis  muscle,  38 
longus  pollicis  muscle,  38 
External   cutaneous   nerves  of  arm 

163 

of  thigh,  i6,c 
saphenous  nerve,  173 

vein,  108 
Eye-ball,  239 
brows,  237 
lashes,  237 
lids,  237 

muscles  of,  n 
structure,  237 

Facial  artery,  66 
nerve,  151 
vein,  99 

Falciform  ligament  of  the  liver,  192 
border  of  saphenous  open 
ing,  50 


Fallopian  tube,  227 
Falx  cerebelli,  140 

cerebri,  139 
Fascia,  axillary,  32 

brachial,  35 

cervical,  deep,  26 

costo-coracoid,  32 

cremasteric,  222 

cribriform,  501 

of  Colles,  47 

of  the  forearm,  35 

iliac,  50 

intermuscular  of  the  humerus, 

of  the  thigh,  49 
lata,  49 
lumborum,  45 
masseteric,  25 
obturator,  47 
of  the  leg,  56 
of  the  pyriformis,  48 

perinaeal,  deep,  47 

superficial,  47 
plantar,  deep,  57 
recto-vesical,  48 
temporal,  25 
transversalis,  222 
triangularis,  44 
Fasciculus  teres,  121 
Femoral  artery,  90 

vein,  109 

Femoro-tibial  articulation,  15 
Fenestra  ovalis,  231 

rotunda,  232 
Fibres  of  the  cerebrum,  138 

of  the  cerebellum,  1 24 
Fifth  nerve,  142 

ventricle  of  brain,  136 
Filiform  papillae,  182 
Fillet  of  the  olivary  body,  120 
Filum  terminate,  114 
First  nerve,  141 
Fissure,  longitudinal,  130 

paneto-occipital,  130 
of  Rolando,  130 
of  Sylvius,  130 
transverse,  130 
Fissures  of  Santorini,  231 
of  the  cord,  115 
of  the  cerebrum ,  130 
Flexor  accessorius  muscle,  58 

brevis  minimi  digiti  muscle,  ^9 
pedis  muscle, 

carpi  radialis  muscle,  36 
ulnaris  muscle,  36 
digitorum  brevis  pedis  muscle, 

58 

longus  pedis  muscle, 
56 


252 


INDEX 


Flexor  digitorumprofundusmuscle,36 
sublimis  muscle,  36 
hallucis  longus  muscle,  56 
brevis  muscle,  58 
pollicis  longus  muscle,  37 
brevis  muscle,  39 
Flocculus  cerebelli,  124 
Fold  of  Douglas,  45 
Follicles,  Meibomian,  238 
Foramen  of  Monro,  137 

for  inferior  vena  cava,  46 
of  Winslow,  201 
ovale,  206 

Foramina  Thebesii,  204 
Fornix,  136 
Fossa  navicular  of  the  urethra,  221 

of  the  pudendum,  225 
ovalis,  205 

Fossae  of  abdominal  wall,  198 
Fourth  nerve,  142 

ventricle,  120 
Fovea  centralis,  242 

hemispherica,  234 
hemi-elliptica,  234 
Foveae  of  fourth  ventricle,  121 
Fraenum  linguae,  18  c 

praeputii,  221 
Frontal  artery,  72 
lobe,  131 
nerve,  143 
vein,  98 

Fungiform  papillae,  181 
Funiculus  cuneatus,  119 
gracilts,  119 
of  Rolando,  119 

Galen,  veins  of,  97,  137 
Gall  bladder,  193 
Ganglia,  cervical,  inferior,  178 
middle,  177 
superior,  176 
lumbar,  178 
of  spinal  nerves,  158 
sacral,  178 
semilunar,  179 
thoracic,  178 

Ganglion  of  the  vagus,  155 
Gasserian,  142 
impar,  179 
jugular,  154 
lenticular,  143 
Meckel's,  145 
ophthalmic,  150 
otic,  148 
petrosal,  154 
spheno-palatine,  145 
submaxillary,  148 
Gastric  arteries,  83 


Gastric  plexus,  180 

vein,  107 

Gastro-colic  omentum,  199 
epiploic  arteries,  83 

vein,  108 

hepatic  omentum,  199 
Gastrocnemius  muscle,  55 
Gemellus  inferior  muscle,  54 
superior  muscle,  54 
Geniculate  bodies,  128 
Genio-hyo-glossus  muscle,  29 

hyoid  muscle,  29 
Genital  organs,  220 
Genito-crural  nerve,  168 
Gimbernat's  ligament,  44 
Gland,  lachrymal,  238 
parotid,  183 
pineal,  129 
pituitary,  129 
prostate,  220 
sublingual,  185 
submaxillary,  184 
Glands,  axillary.  112 

Bartholm's,  225 
bronchial,  113 
Brunner's,  190 
cardiac,  113 
cervical,  in 
concatenate,  in 
Cowper's,  220 
inguinal,  113 
intercostal,  113 
intestinal,  112 
lingual,  182 
lumbar,  112 
mediastinal,  113 
Meibomian,  237 
mesenteric,  112 
oesophageal,  113 
of  Pacchioni,  139 
pelvic,  112 
Peyer's,  190 
popliteal,  113 
sternal,  113 
Glans  of  the  clitoris,  225 

of  the  penis,  220 
Glenoid  ligament,  10 
Glisson's  capsule,  194 
Globus  major  epididymis,  2*3 
minor  epididymis,  223 
Glosso-pharyngeal  nerve,  153 

nucleus,  122 
Glottis,  210 
Gluteal  artery,  90 

nerve,  superior,  171 
nerves,  inferior,  171 
Glutens  maximus  muscle,  53 
medius  muscle,  53 


INDEX 


Glutens  minimus  muscle,  53 

Gracilis  muscle,  52 
Grey  commissure  of  llie  cord,  116 
crescent  of  the  cord,  1 15 
substance  of  the  corpus  stria - 

turn,  137 
substance  of   the  medulla   ob- 

longata,  123 
substance  of  the  third  ventricle, 

128 

tubercle  of  Rolando,  119 
Great  omentum,  199 
Gustatory  nerve,  147 
Gyrus  fornicatus,  134 

Hittnorrhoidal  artery,  inferior,  87 
middle,  86 
superior,  85 
nerve,  inferior,  172 
plexus,  180 
veins,  109 

Hamulus  laminae  spiralis,  235 
Heart,  202 
Helicotrema,  235 
Helix,_230 
Hepatic  artery,  82 
duct,  194 
plexus,  180 
veins,  106 
Hip-joint,  14 
Hippocampus  major,  136 
minor,  136 
Hunter's  canal,  53 
Hyaloid  membrane,  243 
Hymen,  225 
Hyo-glossus  muscle,  29 
Hypogastric  artery,  86 

plexus  of  nerves,  180 
Hypoglossal  nerve,  157 
nucleus,  13* 

Ileo-caecal  valve,  190 
Ileo-colic  artery,  84 
lleum,  189 

Iliac  artery,  common,  85 
external,  88 
internal,  86 
colon,  191 
fascia,  50 

vein,  common,  no 
external,  109 
internal,  109 
Iliacus  muscle,  51 
Ilio-costalis  muscle,  42 
Ilio-femoral  articulation,  15 
hypogastric  nerve,  168 
inguinal  nerve,  168 
lumbar  artery,  88 


Incisor  branch  of  nerve,  147 

teeth,  181 
Incus,  233 
Inferior  cornu  of  the  lateral  ventricle, 

i3S 

maxillary  nerve,  148 
Infra-orbital  artery,  70 

nerves,  144,  153 
vein,  99 

scapular  artery,  03 
spinatus  muscle,  34 
trochlear  nerve,  143 
Infundibulum  of  the  brain,  129 
Inguinal  canal,  223 
glands,  113 
Innominate  artery,  80 
veins,  103 

Interarticular  cartilage  of  the  jaw,  4 
of  the  hip,  14 
of  the  knee,  15 
of  the  ribs,  5 
of  the  scapula,  9 
sacro-iliac,  7 
sterno-clavicular,  8 
of  the  symphysis,  8 
of  the  vertebrae,  2 
of  the  wrist,  12 
Interclavicular  ligament,  8 
Intel-columnar  fascia,  44  [81 

Intercostal  arteries,  anterior  branches, 
posterior  branches, 
artery,  superior,  64        [81 
muscle,  external,  45 
internal,  46 
nerves,  166 

cutaneous  anterior,  1 66 
lateral,  166 
veins,  superior,  104 
Intercosto-humeral  nerve,  166 
Intermuscular  septa  of  the  arm,  34 
of  the  foot,  57 
of  the  thigh,  50 
Internal  cutaneous  nerve  of  the  arm, 

163 
of  the  thigh. 

169 
sapbenous  nerve,  170 

vein,  108 

Interosseous  arteries  of  the  foot,  95 
of  the  hand,  77 
artery,  anterior,  78 
posterior,  78 
ligament  of  the  arm,  n 
of  the  leg,  17 
muscles  of  the  foot,  59 

of  the  hand,  40 
nerve,  anterior,  164 
posterior,  165 


254 


INDEX 


Interspinal  muscles,  43 
Intertransverse  muscles,  43 
Intervertebral  substances,  2 
Intestinal  arteries,  84 
Intestine,  large,  190 
small,  1 83 
Iris,  241 

nerves  of,  242 

structure  of,  241 

vessels  of,  241 
Island  of  Reil,  133 
Isthmus  of  the  thyroid  body,  215 
Iter  a  tertio  ad  quartum  ventriculum, 
126 

Jacobson's  nerve,  154 
Jejunum,  189 
Joint,  ankle,  18 
elbow,  10 
hip,  14 
knee,  15 
lower  jaw,  4 
shoulder,  10 
thumb,  13 
wrist,  12 
Jugular  ganglion,  154 

vein,  anterior,  100 
external,  100 
internal,  101 

Kidney,  2x6 

connections  of,  216 
Knee  of  the  corpus  callosum,  135 
joint,  15 

Labia  pudendi  externa,  225 
interna,  235 

Labial  artery,  inferior,  67 
Labyrinth,  234 

membranous,  235 

osseous,  234 
Lachrymal  artery,  71 

canals,  238 

duct,  238 

gland,  238 

nerve,  143 

sac,  238 

Lacunae  of  the  urethra,  aaa 
Lamina  cinerea,  129 

spiralis  cochlea;,  235 
Laminae  of  cerebellum,  124 
Large  intestine,  connections,  190 
Laryngeal  arteries,  62,  66 

nerve,  external,  156 
inferior,  156 
superior,  156 

pouch,  ?TO 
Larynx,  207 


Larynx,  aperture  of,  209 
cartilages  of  207 
interior  of,  210 
ligaments,  209 
muscles,  30 
nerves,  156] 
ventricle,  210 
vessels,  62,  66 
Lateral  column  of  the  medulla,  119 

of  the  cord,  115 
sinus,  98 
ventricles,  135 
Latissimus  dorsi  muscle,  40 
Lens,  243 

Lenticular  ganglion,  143 
Levator  anguli  oris  muscle,  24 

scapulae  muscle,  41 
ani  muscle,  49 
labii  superioris  muscle,  24 

alaeque   nasi, 
muscle,  23 
inferioris  muscle,  24 
palati  muscle,  30 
palpcbras  superioris  muscle, 

22 

Levatores  costarum  muscle,  46 
Ligament  of  the  lung,  212 
Ligaments  of  the  bladder,  48,  197 
of  the  larynx,  209 
of  the  ovary,  227 
of  the  uterus,  227 
Ligament,  acromio  clavicular,  9 
alar  of  the  knee,  17 
annular,     anterior    of    the 

ankle,  57 
external    of    the 

ankle,  57 
anterior    of    the 

Wris-t>I3r    v 
posterior  of   the 

wrist,  13 
anterior  of  ankle,  18 

of  elbow-joint,  10 
of  knee-join*,  16 
of  wrist -joint,  *a 
of  carpus,  13 
astragalp-scaphoid,  19 
atlo-axoid,  anterior,  3 
posterior,  j 

transverse,  3 
calcaneo-astragaloid,  19 
cuboid,  19 
scaphoid,  19 
capsular  of  the  hip,  14 
of  the  knee,  16 
of  the  shoulder,  to 
of  the  thumb,  13 
carpal,  dorsal,  12 


INDEX 


255 


Ligament,  carpal,  palmar,  12 
carpo-metacarpal,  13 
check, 4 

common,   anterior     of  ver- 
tebrae, 2 

common,  posterior,  2 
conoid,  9 

coraco-acromial,  9 
clavicular,  9 
humeral,  10 
coronary,  17 
costo-clavicular,  9 
coracoid,  32 
transverse,  anterior,  5 
middle,  5 
posterior  5 
vertebral,  5 
cotyloid,  15 
crico-thyroid,  209 
crucial,  16 
deltoid,  18 

dorsal  of  the  carpus,  12 
of  Gimbernat,  44 
plenoid,  10 
ilio-femoral,  15 
lumbar,  6 

interartieular    of    the    cla- 
vicle, 9 
of  the  hip,  15 
of  the  jaw,  4 
of  the  knee,  16 
of  the  pubes,  8 
of  the  ribs,  5 
interclavicular,  8 
interosseous    of   astragalus 

and  os  calcis,  19 
of  carpus,  13 
of  cuneiform  bones,  19 
of     metacarpal     bones, 

13 

of  metatarsal  bones,  20 
of  radius  and  ulna,  n 
of    the     scaphoid    and 

cuboid,  19 
of  the  tibia  and  fibula, 

17 
inferior,  of  the  tibia  and 

fibula,  18 
interspinous,  2 
intertransverse,  3 
intervertebral,  2 
ischio-capsular,  15 
lateral,    external     of     the 

ankle,  18 
internal     of      the 

ankle,  18 

external      of     the 
carpui,  13 


Ligament,    lateral,    internal    of   the 

carpus,  13 
external      of     the 

elbow,  ii 
internal      of      the 

elbow,  ii 
pnalangeal   of  the 

foot,  20 
phalangeal  of  the 

hand, 14 
external      of     the 

jaw,  4 
internal      of      the 

jaw,  4 
external     of     the 

knee,  16 
internal      of      the 

knee,  16 
external     of     th*; 

wrist,  12 
internal       of      the 

wrist,  12 
long  plantar,  19 
lumbo-sacral,  6 
metacarpal,  dorsal,  13 

palmar,  13 

metacarpo-phalangeal,  14 
metatarsal,  dorsal,  20 

plantar,  30 
mucous,  17 
obturator,  8 

occipito-atloid,  anterior,  3 
lateral,  4 
posterior,  4 
occipito-axoid,  4 
odontoid,  4 

orbicular  of  the  radius,  ii 
of  the  patella,  15 
peroneo-tibial,  17 
of  Poupart,  44 
posterior  of  carpus,  13 
of  elbow,  ii 
of  knee,  15 
of  scapula,  9 
of  wrist,  12 

proper  of  the  scapula,  9 
pubic,  anterior,  8 
posterior,  8 
superior,  8 
pubp-  femoral,  15 
radio-ulnar,  ii 
rhomboid,  9 
round  of  the  hip,  15 
round  of    the    radius    and 

ulna,  ii 
sacro-coccygeal,  anterior,  8 

posterior, 
sacro-iliac,  anterior,  7 


256 


INDEX 


Ligament,  sacro-iliac,  posterior,  7 
sacro-sciatic,  great,  7 
small,  7 

sacro-vertebral,  6 
of  the  scapula,  transverse,  9 
sternal,  anterior,  6 
posterior,  6 
sterno-clavicular,  8 
stylo-hyoid,  5 

maxillary,  4 
sub-pubic,  8 
supraspinous,  2 
suspensory  of  penis,  220 
tarso-metatarsal,  dorsal,  20 
plantar,  20 
thyro-arytenoid,  209 

epiglottidean,  210 
hyoid,  209 
tibio-fibular,  17 
transverse  of  the  atlas,  3 

of    the     fingers, 

of  the  hip,  15 
of  the  knee,  17 
of  metacarpus,  14 
of  metatarsus,  20 
of  scapula,  9 
trapezoid,  9 
Ligament,  triangular  of  the  urethra, 

of  Winslow,  posterior,  15 
Ligamenta  alaria,  17 

subflava, 2 
Ligamentum  arcuatum,  46 

denticulatum,  116 
arteriosum,  215 
latum  pulmonis,  214 
longum  plantae,  19 
mucosum,  17 
nuchse,  2 
patellae,  15 

posticum  Winslowii,  15 
spirale,  236 
subflavum,  a 
teres,  15 
Limbus,  236 
Linea  alba,  44 
Linear  transversae,  45 
Lingual  artery,  66 
glands,  in 
nerve,  147,  154 
vein,  101 

Linguales  muscles,  182 
Liquor  Cotunnii,  234 
Liver,  192 

connections  of,  192 
ligaments,  192 
vessels,  194 


Lobes  of  the  cerebellum,  1 24 
of  the  cerebrum,  131 
of  the  testis,  223 
of  the  liver,  193 
Lobus  auris,  230 

caudatus,  193 
quadratus,  193 
Spigelii,  193 
Locus  niger,  126 

perforatus  anticus,  129 
posticus.  120 

Longissimus  dorsi  muscle,  42 
Longitudinal  fibres  of  the  brain,  135 
fissure  of  the  liver,  193 
sinus,  inferior,  98 
superior,  97 
Longus  colli  muscle,  31 
Lumbar  aponeurosis,  45 
arteries,  85 

anterior    branches, 

85 
posterior  branches, 

85 

ganglia,  178 
glands,  112 
nerves,  anterior  branches, 

167 
posterior  branches, 

167 

plexus,  167 
veins,  105 

Lumbo-sacral  nerve,  167 
Lumbricales  muscles  of  the  foot,  56 

of  the  hand,  39 
Lungs,  212 

connections,  213 
Lymphatic  duct,  right,  in 
Lymphatics  of  the  arm,  112 
of  the  axilla,  na 
of  the  groin,  113 
of  the  lungs,  113 
of  the  mesentery,  112 
of  the  neck,  in 
of  the  pelvis,  112 
of  the  popliteal  space, 

113 

of  the  thorax,  113 
Lyra,  137 

Malleolar  arteries,  94 
Malleus,  232 

muscles  of,  233 

Mammary  artery,  internal,  63 
Masseter  muscle.  25 
Masseteric  artery,  70 
nerve,  146 

Maxillary  artery,  internal,  69 
nerve,  inferior.  146. 


INDEX 


257 


Ma  .illary  nerve,  superior,  144 

vein,  internal,  100 
Meatus  auditorius  ex t emus,  230 

urinarius,  221,  225 
Meatuses  of  the  nose,  228 
Meckel's  ganglion,  145 
Median  basilic  vein,  102 
cephalic  vein,  ioa 
nerve,  163 
vein,  IDS 

Mediastinal  arteries,  81 
Mediastinum  of  thorax,  201 

of  testis,  223 
Medulla  oblongata,  118 

grey  matter,  122 

structure  of,  118 

Medullary  subiiance  of  the  kidney, 

217 

Medullary  velum,  inferior,  125 
superior,  122 
Meibomian  follicles,  238 
Membrana  basilaris,  237 
sacciformis,  12 
tympani,  233 
Membrane,  hyaloid,  243 

of  the  labyrinth,  235 
obturator,  8 
of  Reissner,  236 
Membranes  of  the  brain,  139 

of  spinal  cord,  116 
Membranous  labyrinth,  235 

part    of    the    cochlea, 

236 

part  of  the  urethra,  221 
Meningeal  artery,  anterior,  71 
middle,  69 
posterior,  61 
small,  69 

Mesenteric  artery,  inferior,  84 
superior,  83 
glands,  ii2 
plexus,  inferior,  180 
superior,  180 
vein,  inferior,  107 
superior,  107 
Meso-caecum.  200 

colon,  pelvic,  194 

transverse,  200 
Metacarpal  arteries,  77,  78 
Metatarsal  artery,  95 
Mitral  valve,  206 
Modiolus  of  the  cochlea,  235 
Molar  teeth,  181 
Mons  Veneris,  295 
Motor  oculi  nerve,  142 
Mucous  ligament,  17 
Multifidus  spinae  muscle,  43 
Musculi  papillares,  205 


Musculi  pectinati,  205 
Muscnlo-cutaneous  nerve  of  the  arm, 

163 

phrenic  artery,  63 

spiral  nerve,  165 

Muse.,   abductor  digiti  minimi,  39 

digi  ti    minimi 

pedis,  58 
hallucis,  58 
indicis,  40 
pollicis,  39 
accessorius  pedis,  58 
accessorius  ad  sacro-lumba- 

lem,  42 
adductor  breyis,  52 

obliquus  hallucis, 

longus,  52 
magnus,  52 
obliquus    pollicis, 

39 

transver- 
sus,  39 

transversus  hallu- 
cis, 58 

anconeus,  38 

arytenoideus,  31 

attollens  aurem,  22 

attrahens  aurem,  22 

azygos  uvulae,  30 

biceps  fempris,  54 
cubiti,  35 

biventer  cervicis,  43 

brachialis  anticus,  35 

buccinator,  24 

cervicalis  ascendens,  41 

ciliaris,  241 

coccygeus,  49 

complexus,  43 

compressor  naris,  23 

constrictor,  inferior,  29 
medius,  29 
superior,  29 

coraco-brachialis,  34 

oorrugator  supercilii,  22 

cremastericus,  44 

cricu  -  arytenoideus    latera- 
l's, 3i 

crico  -  arytenoideus     posti- 
cus,  31 

crico-thyroideus,  30 

cnireus,  52 

deltoideus,  33 

depressor  anguli  oris,  24 

depressor    labii     infenoris, 

alas  nasi,  23 
diaphragma,  46 


INDEX 


Muse.,  digastricus,  28 
dilatator  naris,  24 

vlusc.  ,  infra-spinatus,  34 
intercostales  extcrm,  4\, 

pupillae,  241 

interni,  46 

ejaculator  urinse,  49 

interossei   manus  dorsales, 

erector  clitoridis,  49 

40 

penis,  49 

interossei  manus  palmares, 

spinae,  42 

4° 

extensor       carpi       radialis 

interossei  pedis  dorsales,  59 

brevior,  37 
carpi    radialis 

interossei  pedis  plantares,  59 
inter-spmales,  43 

longior,  37 

inter-transversales,  43 

carpi  ulnaris,  38 
digitorum       brevis 

latissimus  dorsi,  40 
levator  anguli  oris,  24 

pedis,  57 

scapula:,  41 

digitorum         corn- 

ani,  49 

munis,  37 

labii  superioris,  24 

digitorum      longus 

labii  superioris  alas- 

pedis,  55 

que  nasi,  23 

indicis,  38 
minimi  digiti,  37 
ossis  metacarpi  pol- 

palati, 30 

paipebrffi  superioris, 

22 

licis,  38 

levatores  costarum,  46 

proprius  hallucis,  55 

linguales,  182 

brevis     pollicis, 

longissimus  dorsi,  42 

38 

longus  colli,  31 

longus    pollicis, 

lumbricales  manus,  39 

38 

pedis,  58 

flexor  accessorius,  58 

massetericus,  25 

brevis  digiti  minimi, 

multindus  spinae,  43 

39 
brevis  digiti   minimi 

mylo-hyoideus,  28 
obliquus    abdominis   exter- 

pedis,  59 

nus,  44 

brevis  hallucis,  58 

obliquus  abdominus    inter- 

brevis  pollicis,  39 

nus,  44 

carpi  radialis,  36 

obliquus  capitis  inferior,  32 

ulnaris,  36 

superior,  32 

digitorum          brevis 

oculi  inferior,  23 

pedis,  58 

superior,  23 

digitorum         longus 

obturator  externus,  54 

pedis,  56 

internus,  54 

digitorum  profundus, 

occipi  to-frontal  is,  21 

36 

omo-hyoideus,  28 

digitorum     sublimis, 

opponens  minimi  digiti,  39 

hallucis  longus,  56 

pollicis,  39 
orbicularis  oris,  24 

pollicis  longus,  37 

palpebrarum,  23 

pastrocnemius,  55 
gemellus  inferior,  54 

palato-glossus,  30 
pharyngeus,  30 

superior,  54 

palmaris  brevis,  39 

genio-hyo-glossus,  29 

longus,  36 

hyoideus,  29 

pectin  eus,  52 

gluteus  maximus,  53 

pectoralis  major,  33 

medius,  53 

minor,  33 

minimus,  53 

peroneus  brevis,  56 

gracilis,  52 
hyo-glossus,  29 

longus,  56 
tertius,  55 

ihacus,  51 

plantaris,  55 

ilio-costalis,  4.* 

platysma  myoides,  26 

INDEX 


25$ 


Muse.,  popliteus,  56 
pronator,  quadratus,  37 

Muse.,  sterno-thyroideus,  28 
stylo-glossus,  29 

radii  teres,  36 

hyoideus,  28 

psoas  ma  gnus,  51 
parvus,  51 

pharyngeus,  30 
subanconeus,  35 

pterygoideus  externus,  25 
internus,  25 

subclavius,  33 
subcostales,  46 

pyramidal  is  abdominis,  45 
nasi,  23 

subcrureus,  52 
subscapularis,  34 

pyriformis,  53 

supinator  brevis,  38 

quadratus  femoris,  54 

longus,  37 

luiuborum,  45 

supra-spinatus,  34 

quadriceps  extensor,  51 
rectus.  abdominis,  45 

temporalis,  25 
tensor  palati,  30 

capitis  anticus  major, 

tarsi,  22 

3i 
capitis  anticus  minor, 

tympani,  233 
fasciae  femoris,  51 

3* 

terei  major,  34 

lateralis,  31 

minor,  34 

posticus  major, 

thyro-arytenoideus,  30 

3a. 
posticus  minor, 

hyoideus,  28 
tibialis  anticus,  55 

32 

posticus,  56 

femoris,  52 

trachelo-mastoideus,  42 

oculi  externus,  23 

transversalis  abdominis, 

inferior,  23 

44 

internus,  23 

coin,  42 

superior,  23 

transversus  perinan,  49 

retraheus  aurem,  22 

trapezius,  40 

rhomboideus  major,  41 

triangularis  sterni,  46 

minor,  41 

triceps  extensor,  35 

ri«orius,  25 

vastus  externus,  51 

roiatores  dorsi,  43 

internus,  52 

salpingo-pliaryngeus,  30 

zygomaticus  major,  24 

sartonus,  51 

minor,  24 

scalenus  anticus,  31 

Mylo-hyoid  artery,  70 

medius,  31 

muscle,  28 

posticus,  32 

nerve,  147 

«emi-membranosus,  54 

spinalis  colli,  43 

Nares,  229 

dorsi,  43 
tendinosus,  54 

Nasal  artery,  72 
lateral,  67 

serratus  magnus,  33 
posticus  inferior,  41 

cartilages,  228 
duct,  238 

superior,  4  1 

fossae,  228 

soleus,  55 

nerve,  143 

sphincter  am  externus,  48 

Naso-palatine  artery,  70 

internus,  48 

nerve,  145 

pupillae,  241 

Nerve  of  Jacobson,  154 

vaginae,  49 
spinalis  dorsi,  42 
splenius  capitis,  41 

of  Wrisberg,  163 
Nerve  to  the  inferior  gemellus  and 
quadratus,  171 

colli,  42 

latissimus,  163 

stapedius.  234 
sterno  -  cleido  -  mastoideus, 

levator  anguli  scapulae, 
162 

•6 

hyoideus,  s% 

longus  colli,  162 
obturator  internus,  171 

17—2 

260 


INDEX 


Nerve  to  the  pectineus,  169 

pterygoid,  internal,  146 
pyriformis,  171 
rhomboid  muscles,  162 
scaleni,  162 
serratus  magnus,  163 
subclavius,  162 
superior  gemellus,  171 
tensor  palati,  148 

tympani,  148 
fasciae   femoris, 

172 

teres  major,  103 
minor,  163 
vastus  externus,  170 
interims,  170 

Nervous  tunic  of  eyeball,  242 
Nerv.,  abducens,  151 

accessories  obturator! us,  169 

spinalis,  157 
acromiales  cutanei,  160 
articularis  poplitei,  173 
articularis  obturatorius,  169 
auditorius,  153 
auricularis  inferior,  147 
magnus,  160 
pneumogastrici,  1 55 
posterior,  152 
auriculo-temporalis,  147 
buccales,  146,  152 
buccinatorius,  152 
cardiacus  inferior,  178 
medius,  178 
pneumogastrici,  156 
superior,  176 
cervicales  nervi  facialis,  153 

rami  anteriores,  1 59 
posteriores,  1 59 
cervicalis  superficialis,  160 
cervico-facialis,  153 
chorda  tympani,  152 
ciliaris    ganglii    ophthalmici, 

»43. 

nasal  is,  143 
circumilexus,  162 
claviculares  cutanei,  160 
coccygealis,  170 
cochlearis,  237 
communicans  fibularis,  175 

tibialis,  173 
cruralis,  169 
cutanei  abdominis  anteriores, 

167 
abdominis     laterales, 

167 

Cutaneus  dorsalis  mauds,  164 
externus  brachialis, 
163 


Nerv.,   cutaneus   externus  lumbalis, 

168 
externus     musculo- 

spiralis,  165 
infra-maxillar.,  153 
interims     brachialis 

major,  163 
internus    brachialis 

minor,  163 
internus  femoris,  169 
internus      muv.ulo- 

spiralis,  165 
medius  femoris,  169 
muse. -cutanei,  163 
palmaris,  164 
plan  tar  is,  174 
radialis,  165 
supra-maxillar.,  153 
dentales  posteriores,  144 
dentalis,  superior,  144,  145 

inferior,  147 

descendens  hypoglossi,  158 
diaphragmaticus,  160,  180 
>ligastricus,  152 
digitales  median!,  164 
plantares,  170 
radiales,  164 
ulnares,  164 

dorsales,  rami  ante:  lores,  166 
posteriores,  166 
dorsalis  penis,  172 

ulnaris,  164 
facialis,  151 
frontalis,  143 
genito-cruralis,  168 

ramus  fempralis,  168 
ramus  genitalis,  168 
glosso-pharyngeus,  153 
glutei  mfenores,  171 
gluteus  superior,  171 
gustatorius,  1^7 
haemorrhoidahs  inferior,  17* 
hepatici,  180 
hypoglossalis,  157 
iho-hypogastricus,  1 68 

inguinalis,  168 
incisorius,  147 

infra-mandibularis  facialis,  153 
orbitales    nervi   facialis. 

X53 

orbitalis,  144 
trochlearis,  143 
intei  costales,  166 
iotercosto-cutanei   anteriores, 

166 
intercosto  •  cutanei     laterales 

166 
intercosto  humer.Uis,  166 


INDEX 


261 


interosseous  anticus,  164 
posticus,  165 
ischiaticus  magnus,  173 

par  v  us,  172 
labialis,  1^5 
lachrymahs,  143 
laryngeus  externus,  156 
inferior,  156 
superior,  156 
Hngualis,  147,  154 
iumbales  rami  anteriores,  167 
posteriores,  167 
lombo-sacralis,  167 
malaris  nervi  facialis,  153 
raassetericus,  146 
maxillaris  inferior,  146 
superior,  144 
median  us,  163 
motor  oculi,  143 
musculo-cutaneus  brachii,  163 
cruris,  175 
spiralis,  165 
mylo-hyoideus,  147 
nasalis,  143 
naso-palatmus,  145 
obturatorius,  168 

articularis,  169 
occipitalis  major,  159 
minor,  160 
ffisophageales,  15: 
olfactorius,  141,  230 
ophthalmicus,  143 
opticus,  141 
orbitalis,  144 
palatinus  magnus,  145 
externus,  145 
minor,  145 
palmaris  cutaneus,  164 

ulnaris  profundus,  165 
superficialis,  166 
palpebrales,  145 
patellaris,  170 
perforans  Casserii,  164 
perinaeales  superficiales,  173 
peronealis,  175 
petrosus  superficialis  externus, 

152 
petrosns  superficialis  magnus, 

152 
petrosus  superficialis  parvus, 

u148        • 

pharyngei,  134 

pharyngeus,  146,  154,  156 
phremcus,  160 
plantaris  externus,  174 

profundus,  174 
internus,  174 
pneumogastricus,  155 


Nerv.,  popliteus  externus,  174 

internus,  173 

pterygoidei,  146 

pudendus  inferior,  171 

internus,  171 

pulmonares  anteriores,  1 56 
posteriores,  156 
radialis,  165 

recurrens  articularis,  175 
renales,  176 

sacrales,  rami  anteriores,  170 
posteriores,  170 
saphenus  externus,  174 
internus,  170 
sciaticus  magnus,  173 
parvus,  172 
spermatici,  ifo 
spheno-palati  ii,  144 
splanchnicus  major,  178 
minor,  178 
minimus,  178 
splenici,  180 


stylo-hyoideus,  152 
suboccipitalis,  ratnu 


s  anterior, 


159 


suboccipitalis,      ramus      pos- 
terior, 158 
subscapulares,  162 
superficialis  cordis  dexter,  17(8 
sinister,  ijj 
supra  -  mandibularis       nervi 

facialis,  153 
supra-orbitalis,  143 
scapnlaris,  162 
trochlearis,  143 
sympatheticus  abdominis,  180 
cervicis,  176 
pelvis,  180 
thoracis,  178 

temporales  nervi  facialis,  152 
profundi,  146 
superficialis,  152 
temporo-facialis,  152 

malar.  144 
thoracic!  anteriores,  162 

laterales,  163 
thoracicus  posterior,  1 62 
thyro-hyoideus,  158 
tibialis  anticus,  175 

posticus,  173 
trigeminus,  142 
trochlearis,  143 
tympanicus,  157,  154 
ulnaris,  164 
uterini,  181 
vaginales,  181 
Vidianus,  146 
Ninth  nerve,  153 


262 


INDEX 


Nodule,  125 

Nose,  cartilages,  228 
cavity  of,  228 
meatuses  of,  228 

Nuclei  of  medulla  oblongata,  123 
Nucleus  caudatus,  138 

lenticularis,  138 
Nutritious  artery  of  femur,  92 

of  humerus,  75 
of  tibia,  96 
Nyraphae,  225 

Obliquus  abdominis  externus  muscle, 

44 
mternus  muscle, 

capitis  inferior  muscle,  32 
superior  muscle,  32 
oculi  inferior  muscle,  23 
superior  muscle,  23 
Obturator  artery,  86 
fascia,  47 
membrane,  54 
muscle,  external,  54 
internal,  54 
nerve,  168 
Occipital  artery,  67 
lobe,  131 

Occipital  vein,  100 
sinus,  97 
nerves,  159.  160 
Occipito-atloid  articulation,  3 
ligaments,  3 
axial  ligaments,  3 
frpntalis  muscle,  21 
Odontoid  ligaments,  4 
(Esophagus,  connections  of,  187 
CEsophageal  arteries,  81 
nerves,  157 

rninjj  of  diaphragm,  46 
,  X34 

nerve,  141 
Olivary  body,  120 

fasciculus,  121 

Omentum,  great,  199 

lesser,  199 

splenic,  199 

Omo-hyoid  muscle,  28 

Ophthalmic  artery,  71 

ganglion,  150 
nerve,  143 
veins,  98  _ 
Opponens  minimi  digiti  muscle,  39 

pollicis  muscle,  39 
Optic  commissure,  129 
nerve,  141 
thalamus,  128 
tract,  129 
Ora  serrata,  242 
Orbicular  ligament  of  the  radius,  n 


Orbicularis  oris  muscle,  24 

palpebrarum  muscle,  22 
Organ  of  Corti,  236 
Orifice  of  the  urethra,  227 

of  the  uterus,  227 

of  the  vagina,  225 
Ossicles  of  the  tympanum,  23? 
Os  uteri,  externum,  226 
internum,  227 
Otic  ganglion,  148 
Otoliths,  236 
Ovaries,  227 

Palate,  soft,  183 
Palatine,  arteries,  superior,  70 
artery,  inferior,  67 
nerve,  external,  145 
large,  145 
small,  145 
Palato-glossus  muscle,  -3.0 

pharyngeus  muscle,  30 
Palmar  arch,  deep,  77 

superficial,  78 

nerve  of  the  ulnar,  deep,  164 
superficial,  164 
fascia,  36 

Palmaris  brevis  muscle,  39 
longus  muscle,  36 
Palpebrae,  237 
Palpebral  arteries,  72 

ligament,  238 
Pancreas,  194 

connections,  iv« 
Pancreatic  arteries,  83 

duct,  195 

Pancreatico-duodenal  arteries,  83 
Papilla  lachrymalis,  237 
Papillse  of  the  tongue,  i3t 
Parietal  lobe,  132 
Parotid  gland,  183 
Patellar  nerve,  170 

plexus,  169 
Pectineus  muscle,  52 
Pectoralis  major  muscle,  33 
minor  muscle,  3  3 
Peduncle  of  the  cerebellum,  inferior, 

125 
Peduncle  of  the  cerebellum,  middle, 

125 
Peduncle  of  the  cerebellum,  superior, 

125 
Peduncle  of  the  cerebrum,  126 

of  the  pineal  body,  129 
Peduncular  fibres,  138 
Pelvic  colon,  191 
fascia,  47 
plexus,  180 
Penis,  220 
Perforating  arteries,  of  femoral,  92 

of  internal  mammary,  6j 


INDEX 


263 


Perforating  arteries  of  the  palm,  77 

of  the  sole,  95 

Perforans  Casserii  nerve,  164 
Pericardium,  202 
Perilymph,  234 

Perinaeal  artery,  superficial,  87 
fascia,  deep,  47 

superficial,  47 
nerves,  superficial,  172 
Peritoneum,  196 

of  female  pelvis,  197 
of  male  pelvis,  190 
Peroneal  artery,  96 

anterior,  96 
nerve,  171 
Peroneus  brevis  muscle,  56 

longus  muscle,  56 
tertius  muscle,  55 
Peroneo-tibial  articulations,  17 
Pes  hippocampi,  136 
Petrosal  ganglion,  154 

sinus,  inferior,  98 
superior,  98 

Petrosal  nerve,  external,  152 
large,  152 
small,  148 
Peyer's  glands,  190 
Pharyngeal  ascending  artery,  68 
nerve,  154 
vein,  101 
Pharynx,  185 

muscles  of,  29 
openings  of,  186 
Phrenic  artery,  63,  82 

nerve,  160 

Pia  mater  of  the  brain,  140 
of  the  cord,  116 
Pigment  cells  of  choroid,  240 

of  iris,  241 

Pillars  of  the  abdominal  ring,  44 
of  the  fornix,  136 
of  the  iris,  240 
of  the  soft  palate,  183 
Pineal  body,  129 
Pinna,  or  auricle  of  the  ear,  230 
Pituitary  body,  129 
Plantar  arch,  artery  of  the,  97 
arteries,  96,  97 
fascia,  57 
ligament,  long,  19 
nerve,  external,  174 
internal,  174 
Plantaris  muscle,  55 
Platysma  myoides  muscle,  26 
Pleurae,  212 
Plexus,  aortic,  180 

brachial,  161 

cardiac,  superficial,  179 


Plexus,  cardiac,  deep,  179 
carotid,  177 
cavernous,  177 
cervical,  159 
choroides  cerebri,  137 
coeliac,  180 

coronary,  anterior,  180 
posterior,  180 
of  the  stomach, 

1 80 

diaphragmatic,  180 
gulae,  155 
hamorrhoidal,  180 
hepatic,  180 
hypogastric,  180 
lumbar,  167 

mesenteric,  inferior,  180 
superior,  180 
oesophageal,  155 
ovarian,  181 
patellar,  169 
pelvic,  180 
pharyngeal,  176 
prostatic,  181 
pterygoid  of  veins,  too 
pulmonary,  anterior,  15^ 
posterior,  157 
renal,  180 

supra,  180 
sacral,  171 
solar,  179 
spermatic  of  nerves,  180 

of  veins,  106 
splenic,  180 
tympanic,  154,  177 
uterine,  181 
vaginal,  181 
vesical,  180 
Plica  semilunaris,  237 
Pneumogastric  nerve,  155 
Pomum  Adami,  207 
Pons  Varolii,  122 

structure  of,  1 2  3 
Popliteal  artery,  92 
glands,  113 
nerve,  external,  174 
internal,  173 
vein,  109 

Popliteus  muscle,  56 
Portal  vein,  107 
Porus  ppticus,  242 
Posterior  commissure,  128 

ligament     of     the      knee, 

pyramid,  120 
Poupart's  ligament,  44 
Pouch,  laryngeal,  210 
Prepuce,  221 


264 


INDEX 


Princeps  cprvicalis  artery,  63 

pollicis  artery,  77 
Processus  cochleariformis,  233 

vermiformis,  124 
Pi  ofunda  artery,  inferior,  76 

of  the  neck,  64 
of  the  thigh,  91 
superior,  75 
Promontory,  231 
Pronator  quadratus  muscle,  37 
radii  teres  muscle,  36 
Prostatic  gland,  220 

connections,  220 
urethra,  221 
sinuses,  221 

Psoas  magnus  muscle,  51 
parvus  muscle,  5 i 
Pterygoid  arteries,  70 

nerve,  external,  146 
internal,  146 
plexus  of  veins,  100 
Pterygoideus  externus  muscle,  25 
internal  muscle.  25 
Pterygo-maxillary  ligament,  25 

palatine  artery,  70 
Pubp-prostatic  ligaments,  48 
Pudic  arteries,  external,  91 
artery,  internal,  87 
nerve,  internal,  171 
Pulmonary  artery,  214 
nerves,  156 
veins,  106 
Pylorus,  187 
Pyloric  arteries,  83 
Pyramid,  anterior,  120 

decussation  of,  120 
of  the  cerebellum,  125 
of  the  tympanum,  232 
posterior,  119 
Pyramidal  fibres  of  the  medulla,  12 

masses  of  kidney,  217 
i'yi  amidalis  abdominis  muscle,  45 

nasi  muscle,  23 
Pyramids  of  Malpighi,  217 
Pyriformis  muscle,  53 

Quadratus  femoris  muscle,  54 

lumborum  muscle,  45 

Radial  artery,  76 

nerve,  165 

veins,  102 

Radialis  indi^is  artery,  77 
Radio-carpal  articulation,  12 
Radio-ulnar  articulations,  n 
Ranine  artery,  66 

vein,  101 
Raph6  of  the  corpus  callosum,  135 

of  the  medulla,  118 


Keceptaculum  chyli,  no 
Recto-resical  fascia,  48 

pouch, 197 
Rectus  abdominis  muscle,  45 

capitis  anticus  major  muscle, 

31 
minor  muscle, 

31 

lateralis  muscle,  31 
posticus  major  muscle, 

32 
minor  muscle, 

32 

femoris  muscle,  52 
oculi  externus  muscle,  23 
inferior  muscle,  23 
internus  muscle,  23 
superior  muscle,  23 
Rectum,    connections     of,     in     the 

female,  191 
Rectum,    connections    of,     in     the 

male,  191 

Recurrent  interos&tous  artery,  78 
radial,  76 
tibia!,  97 

ulnar,  anterior,  78 
posterior,  78 
Recurrent  nerve  of   pneumogastric, 

*55 

Recurrent  nerve  of  the  tibial,  175 
Renal  artery,  84 
plexus,  180 
vein,  106 

Restiform  body,  119 
Kete  testis,  224 
Retina,  242 

Retrahens  aurem  muscle,  22 
Rhomboideus  major  muscle,  41 
minor  muscle,  41 
Rima  of  the  glottis,  210 
Risorius  muscle,  25 
Root  of  the  lung,  213 
Rotatores  dorsi  muscles,  43 
Round  ligament  of  the  hip-joint,  14 
of  the  liver,  192 
of  the  uterus,  227 

Saccule  of  the  ear,  235 
Sacculus  laryngis,  210 
vestibuli,  235 
Sacral  artery,  lateral,  S3 
middle,  85 
ganglia,  180 

nerves,  anterior  branches,  170 
posterior  branches, 

170 

plexus,  171 

Sacro-coccygeal  articulation,  8 
iliac  articulation,  7 
vertebral  articulation,  6 


INDEX 


265 


Sacro-sciatk  ligament,  large,  7 
small,  7 

Salpingo-pharyngeus  muscle,  30 
Salvatella  vein,  101 
Saphenous  vein,  external,  108 
internal,  108 
opening,  50 
nerve,  external,  174 
internal,  170 
Sartorious  muscle,  51 
Scala  tynipani,  235 
vestibuli,  235 

Scalenus  anticns  muscle,  31 
medius  muscle,  31 
posticus  muscle,  3* 
Scapular  artery,  posterior,  63 
ligaments,  9 
muscles,  34 

Scapulo-clavicular  articulation,  9 
humeral  articulation,  10 
Schneiderian  membrane,  229 
Sciatic  artery,  89 

nerve,  large,  173 
small,  172 

Sclerotic  coat  of  the  eye,  239 
Scrotum,  222 
Second  nerve,  141 

Secondary  membrane    of   the    tym- 
panum, 231 

Semicircular  canals,  234 
Semilunar  cartilages,  16 
ganglia,  179 
valves  of  aorta,  206 

of    pulmonary     ar- 
tery, 205 

Semi-membranosus  muscles,  54 
Seminal  ducts,  224 
Seminiferal  tubes,  223 
Semi  spinalis  coli  muscle,  43 

dorsi  muscle,  43 
Semi-tendinosus  muscle,  54 
Septum  auricularum,  204 
cochleae,  236 
crurale,  50 

intermuscular,  of  the  arm,  34 
of  the  thigh, 

49 

iucidum,  136 
nasi,  229 
pec tini forme,  221 
scroti,  222 
of  the  tongue,  182 
ventriculorum,  204 
Serratus  magnus  muscle,  33 
posticus  inferior,  41 
superior,  41 
Seventh  nerve,  151 


Sheath  of  the  rectus,  45 
Shoulder-joint,  10 
Sigmoid  artery,  85 
Sinus,  cavernous,  98 
circular,  98 
coronary,  106 
lateral,  98 
longitudinal,  inferior,  98 

superior,  97 
occipital,  98 
petrosal,  inferior,  98 
superior,  98 
pocularis,  221 
prostaticus,  221 
straight,  of  the  skull,  98 
transverse,  98 
of  Valsalva,  205 
Sixth  nerve,  151 
Small  intestine,  188 
omentum,  199 
Socia  parotidis,  184 
Soft  commissure,  128 
Soft  palate,  183 

muscles  of,  30 
Solar  plexus,  179 
Soleus  muscle,  55 
Spermatic  artery,  84 
cord,  2*2 
plexus,  180 
veins,  106 
Spheno-palatine  artery,  70 

ganglion,  145 
nerves,  144 

Sphincter  ani  externus  muscle,  48 
internus  muscle,  48 
of  the  pupil,  241 
vaginae,  49 
Spigelian  lobe,  192 
Spinal  accessory  nerve,  157 
arteries,  61 
cord,  114 

membtane  of,  116 
structure,  115 
nerves,  158 

roots  of,  158 
veins,  105 

Spinalis  dorsi  muscle,  42 
Spiral  tube  of  the  cochlea,  235 
Splanchnic  nerve,  large,  178 
small,  178 
smallest,  178 
Spleen,  195 

connections,  195 
Splenic  artery,  83 

omentum,  199 
plexus  of  nerves,  180 
vein,  107 


266 


INDEX 


Splenius  capitis  muscle,  41 

colli  muscle,  42 
Spongy  bones,  228 

part  ofjthe  urethra,  223 
Stapedius  muscle,  234 
Stapes  bone,  233 
Stellate  ligament,  5 
Stenson's  duct,  184 
Sterno-clavicular  articulation,  8 
cleido-mastoid  muscle,  26 
hyoid  muscle.  28 
thyroid  muscle,  28 
St9mach,  form  and  divisions,  187 

connections  of,  188 
Straight  sinus,  98 
Striate  body,  137 
Stylo-glossus  muscle,  29 
hyoid  ligament,  5 
muscle,  28 
nerve,  152 
mastoid  artery,  68 
maxillary  ligament,  25 
pharyngeus  muscle,  30 
Subanconeus  muscle,  35 
Subarachnoid  space,  140 
Subclavian  artery,  left,  59 

right,  59 
vein,  103 

Subclavius  muscle,  33 
Subcostales  muscles,  46 
Subcrureus  muscle,  52 
Subcutaneous  mala?  nerve,  144 
Sublingual  artery,  66 
gland,  185 
Submaxillary  ganglion,  148 

gland,  184 

Submental  artery,  67 
Suboccipit  a  1  nerve,  anterior  branch, 

159 
Suboccipital  nerve,  posterior  branch, 

158 

Subpeduncular  lobe,  124 
Subpubic  ligament,  £ 
Subscapular  artery,  74 
nerves,  162 

Subscapularis  muscle,  34 
Sulci  of  brain,  131 

Sulcus,  longitudinal,  of  the  liver,  193 
spiralis,  236 
transverse,  193 
Superficialis  cervicahs  artery,  63 

volae  artery,  76 

Supinator  radii  brevis  muscle,  38 
longus  muscle,  37 
Supra-orbital  artery,  72 
nerve,  143 
renal  capsule,  217 
plexus,  i So 


Supra-scapular  artery,  62 
nerve,  162 
spinatus  muscle,  34 
trochlear  nerve,  143 
Suspensory  ligament  of  the  lens,  243 
of  the  liver,  192 
^  of  the  penis,  220 
Sympathetic  nerve  in  the  abdomen, 

1 80 

in  the  head,  176 
in  the  neck,  176 
in  the  pelvis,  180 
in  the  thorax.  178 
Symphysis  pubis,  8 
Synarthrosis,  i 

Taenia  hippocampi,  136 

semicircularis,  138 
Tarsal  artery,  94 
plates,  237 

Tarso-metatarsal  articulations,  20 
Teeth,  181 
Tegmentum,  127 
Temporal  aponeurosis,  25 
arteries,  deep,  69 
middle,  69 
superficial,  68 
fascia,  25 
muscle,  25 
nerves,  deep,  146 

superficial,  152 
vein,  99 

Temporo-fascial  nerve,  152 
malar  nerve,  144 
maxillary  articulation,  4 
sphenoidal  lobe,  133 
Tendo  Achillis,  55 

palpebrarurn,  228 
Tendon      of     quadriceps      extensor 

muscle,  52 

Tensor  fasciae  femoris  muscle.  51 
palati  muscle,  30 
tarsi  muscle,   22 
tympani  muscle,  224 
Tentorium  cerebelli,  139 
Teres  major  muscle,  34 
minor  muscle,  34 
Testes,  223 

Thalamus  opticus,  128 
Thebesian  foramina,  204 

valve,  205 
Third  nerve,  142 

ventricle,  127 
Thoracic  duct,  no 

ganglia,  178 
acromial  artery,  74 
alar  artery,  74 
long  artery,  74 


INDEX 


267 


Thoracic  superior  artery,  74 
Tbymus  body,  215 
Thyro-arytenoid  articulation,  209 

ligaments,  209 
Thyro-arytenoideus  muscle,  30 

epiglottidean  ligament,  209 
hyoid  membrane,  209 
muscle,  28 
nerve,  158 

Thyroid  artery,  inferior,  62 
lowest,  80 
superior,  66 
axis,  62 
body,  215 
cartilage,  207 
plexus  of  veins,  104 
vein,  inferior,  104 
middle,  101 
superior,  101 

Tibial  artery,  anterior,  93 
posterior,  94 
nerve,  anterior,  175 
posterior,  173 
veins,  anterior,  109 
posterior,  109 
Tibialis  anticus  muscle,  55 
posticus  muscle,  56 
Tibio-tarsal  articulation,  19 
Tongue,  181 

muscles  of,  29,  183 
Tonsil,  183 
Tonsillitic  artery,  67 
Torcular  Herophili,  98 
Trabeculae  rarneae,  205 
Trachea,  211 

Trachelo-mastoid  muscle,  41 
Tragus,  230 
Transverse  colon,  190 

fissure  of  the  cerebrum, 

130 

of  the  liver,  193 
ligament  of  the  aceiabu- 

lum,  14 
of  the  atlas,  3 
of  the    fingers, 

14 

of  the  knee,  17 
of     the    meta- 
carpus, 14 
of     the     meta- 
tarsus, 20 
of  the  toes,  21 
perineal  artery,  87 
sinus,  98 

tarsal  articulation,  20 
Transversalis  abdominis  muscle,  44 
cervicalis  artery,  65 
colli  muscle,  42 


'  Transversalis  faciei  artery,  69 
Transversus  perinaei  muscle,  49 
Trapezius  muscle,  40 
Trapezoid  ligament,  9 
Triangular    cartilage    of    the    nose, 

228 

fascia,  44 
nbro-cartilage  of   wrist, 

12 

ligament  of  urethra,  49 
surface  of  bladder,  210 
Triangularis  sterni  muscle,  46 
Triceps  extensor  cubiti  muscle,  35 
Tricuspid  valve,  203 
Trigeminal  nerve,  142 
Trigonum  vesicae,  219 
|  Trochlear  nerve,  infra,  142 
supra,  143 

Tube  of  the  cochlea,  235 
Tuber  cinereum,  129 
Tubercle  of  Rolando,  119 
Tubuli  seminiferi,  223 
Tunica  albuginea  testis,  223 
Ruyschiana,  240 
vaginalis,  223 
vasculosa  testis,  223 
Turbinate  bones,  228 
Twelfth  intercostal  nerve,  167 
Tympanic  artery,  6p,  71 
Tympanum,  231 

Ulnar  artery,  77 
nerve,  164 
veins,  101 

cutaneous  anterior,  101 
posterior,  TOI 
Ureter,  217 
Urethra,  female,  225 

orifice  of,  225 
male,  interior,  221 
Uterine  arteries,  86 

plexus  of  nerves,  181 
veins  and  sinuses,  109 
Uterus,  226 

interior  of,  226 
ligaments  of,  227 
connections  of,  226 
Utricle  of  the  ear,  235 
Uvea  iridis,  241 
Uvula  cerebelii,  125 
palati,  183 


Vagina.  225 
Vaginal  arteries,  86 
plexus,  181 
veins,  109 
Vagus  nerve,  155 
nucleus    u? 


268 


INDEX 


Vallecula,  124 
Valve,  Eustachian,  204 
of  caecum,  125 
mitral,  206 
semilunar,  204 
of  Thebesius,  205 
tricuspid,  205 
ofVieussens,  124 
Valvulae  conniventes,  185 
Vas  deferens,  223 
Vasa  brevia,  188 

efierentia  testis,  224 
rete  testis,  224 
vorticosa,  240 
Vascular  coat  of  eye,  240 
Vastus  externus  muscle,  51 
internus  muscle,  52 
Vein,  alveolar,  99 
angular,  99 

ascending  cervical,  101 
lumbar,  104 
pharyngeal,  102 
auricular  posterior,  100 
axillary,  102 
azygos,  large,  104 
small,  104 
superior,  105 
basilic,  102 
brachial,  102 
bronchial,  left,  105 

right,  105 

cardiac,  anterior,  106 
great,  106 
small,  1 06 
cava,  inferior,  105 
superior,  103 
cephalic,  102 
cerebellar,  97 
cerebral,  97 
chproid,  97 
ciliary,  anterior,  98 
posterior,  98 

circumflex  iliac,  108,  109 
coronary  of  the  heart,  106 

of  the  stomach,  107 
,1  the  corpus  striatum,  97 
deep  cervical,  101 
dorsal  of  the  penis,  109 
dorsi  spinal,  105 
emissary,  99 
epigastric,  deep,  109 

superficial,  108 
facial,  99 
femoral,  109 
frontal,  98 
of  Galen,  97 


gastro-epiploic,  108 
hacmorrhoidal,  109 


Vein,  hepatic,  106 

iliac,  common,  no 
external,  109 
internal,  109 
infra-orbital,  99 
innominate,  103 
intercostal,  105 

superior,  left,  104 

right,  104 

jugular,  anterior,  100 
external,  100 
internal,  left,  101 

right,  101 
laryngeal,  101 
lingual,  loi 

longitudinal  of  the  spine,  an- 
terior, 105 
lumbar,  105 

mammary,  internal,  104 
maxillary,  internal,  100 
median  of  the  arm,  102 
basilic,  102 
cephalic,  102 
mesenteric,  inferior,  107 
superior,  107 
occipital,  TOO 
ophthalmic,  98 
ovarian,  106 
palpebral,  inferior,  99 
superior,  99 
pancreatic,  108 
perineal,  superficial,  no 
pharyngeal,  101 
phrenic,  inferior,  106 
popliteal,  109 
portal,  107 

posterior,  spinal  plexus  of,  105 
profunda,  of  the  thigh,  109 
pterygoid  plexus,  100 
pudic  external,  108 
internal,  no 
pulmonary,  106 
radial  cutaneous,  ioa 
ranine,  101 
renal,  106 
sacral,  lateral,  no 
middle,  no 

saphenous,  external,  108 
internal,  108 
spermatic,  106 
spinal,  105 
splenic,  107 
subclavian,  103 
supra-orbital  99 
renal,  106 
scapular,  100 


thyroid,  inferior, 


104 


INDEX 


269 


Vein,  thyroid,  middle,  101 

superior,  101 
tibia!,  anterior,  109 
posterior,  109 
transverse-cervical,  100 
ainar,  101 

cutaneous,  anterior,  xoz 
posterior,  101 
uterine,  109 
vaginal,  109 
of  the  vertebrae,  105 
vertebral,  101 
vesical,  109 

Velum  interpositum,  137 
Vena  cava,  inferior,  105 
superior,  104 
portas,  107 

Ventricles  of  the  brain,  127,  135 
fifth,  136 
fourth,  120 
lateral,  135 
third,  127 
of  the  heart,  205 

left,  206 
right,  205 
of  the  larynx, 210 
Vermiform  appendix,  190 
processes,  124 


Vertebral  artery,  61  . 

vein,  101 

Verumontanum,  221 
Vesica  urinaria,  218 
Vesical  artery,  inferior,  86 
superior,  86 
plexus  of  nerves,  180 

of  veins,  109 
Vesicula  prostatica,  221 
Vesiculae  seminales,  224 
Vestibule  of  the  ear,  234 

of  the  vulva,  225 

Vestigial  fold  of  the  pericardium,  203 
Vidian  artery,  70 
nerve,  146 
Vitreous  body,  242 
Vocal  cords,  210 
Vulva,  224 

Wharton's  duct,  185 
White  commissure  of  the  cord,  116 
Winslow's  foramen,  201 
Wrisberg's  nerve,  163 
Wrist-joint,  12 

Yellow  spot  of  eye-ball,  242 

Zygomaticus  major  muscle,  24 
minor  muscle,  24 


THE    END 


Bailliere,  Tindall  and  Cox,  8,  Henrietta  Street, 


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